Perspectives and Challenges of Public Health in the United States

1. Perspectives and Challenges of Public Health in the United States Dr. Ted Chen, Ph.D., M.P.H., M.A. Director: Asia-Pacific Health Promotion & Development Professor/Head: Health Education/Communication Program Tulane School of Public Health & Tropical Medicine Tulane University Medical Center

2. 1900 TB 185 Pneumonia/infu 184 Heart dis 153 Enteritis 115 CVA 106 Nephro diseases 84 Accidents 79 Cancers 68 Diphtheria 33 Typhoid fever 27 All causes 1622 Infant mortality: 77 Life expectancy at birth male: 46 female: 48 total: 47 1980 Heart dis 343 Cancer 168 CVA 77 Accidents 48 Pneumonia 23 Diabetes 15 Cirrhosis 14 Arteriosclerosis 13 Suicide 13 Homicide 11 All causes 893 Infant mortality: 13 Life expectancy at birth male: 70 female: 78 total: 74 Mortality & Longevity per 100,000 Population

3. Health Status Change 1900 - 1980 in U.S. • The changes: leading causes, infant mortality, life expectancy, life style • The causes: vaccination, sanitation, medical technology, drug & nutrition • The challenge: rising health care expenditure & prevention/promotion needs

4. 1990 National Health Objectives: Second Revolution of Public Health • Preventive Health Measures • Health Protection • Health Promotion

5. 1990 National Health Objectives • Preventive Health Measures • High blood pressure control • Family planning • Pregnancy and infant health • Immunization • Sexuality transmitted disease • Health Protection • Toxic agent control • Occupational safety and health • Accident prevention and injury control • Fluoridation and dental health • Surveillance and control of infectious diseases • Health Promotion • Smoking and health • Misuse of alcohol and drugs • Nutrition • Physical fitness and exercise • Control of stress and violent behavior

6. The decade achievement • Over-achieved 1/3 of the objectives • under-achieved 1/3 of the objectives • 1/3 of the objectives unmeasurable • American fashion jogging, aerobics and exercise • Eat less meat and more health foods • Smoking rate is dropping • Increase in high blood pressure detection and control • 40% drop in heart disease mortality rate

7. Leading Causes of Death 1997

8. Relationship Between Household Income and Fair or Poor Health Status Source: U.S. Department of Commerce, Bureau of the Census. Current Population Survey. March 1997.

10. The economics of health care costs • The cost of medical services was 12% GNP in 1990 as compared to about 5% in 1960. • Injury alone costs the nation over $100 billion annually, cancers over $70 billion, and cardiovascular diseases $135 billion.

11. Year 2000 National Health Objectives • Health Promotion • Physical activity and fitness • Nutrition • Tobacco • Alcohol and other drugs • family planning • Mental health and mental disorders • Violent and abusive behaviors • Educational and community-based programs • Health Protection • Unintentional injuries • Occupational safety and health • Environmental health • Food and drug safety • Oral health • Preventive Services • Maternal and infant health • Heart disease and stroke • Cancer • Diabetes/Chronic disabling conditions • Immunization and infectious diseases • Chronic preventive services • Surveillance and Data Systems • Age-Related Objectives • Children • Adolescents and Young Adults • Adults • Older Adults

12. A Comparison of The Year 1990 and The Year 2000 National Health Objectives • 2000 Objectives • Health Promotion • Physical activity and fitness • Nutrition • Tobacco • Alcohol and other drugs • family planning • Mental health and mental disorders • Violent and abusive behaviors • Educational and community-based programs • Health Protection • Unintentional injuries • Occupational safety and health • Environmental health • Food and drug safety • Oral health • Preventive Services • Maternal and infant health • Heart disease and stroke • Cancer • Diabetes/Chronic disabling conditions • Immunization and infectious diseases • Chronic preventive services • Surveillance and Data Systems • Age-Related Objectives • Children • Adolescents and Young Adults • Adults • Older Adults • 1990 Objectives • Preventive Health Measures • High blood pressure control • Family planning • Pregnancy and infant health • Immunization • Sexuality transmitted disease • Health Protection • Toxic agent control • Occupational safety and health • Accident prevention and injury control • Fluoridation and dental health • Surveillance and control of infectious diseases • Health Promotion • Smoking and health • Misuse of alcohol and drugs • Nutrition • Physical fitness and exercise • Control of stress and violent behavior

13. Year 2000 National Health Objectives • Health Promotion: A Top Priority • Surveillance and Data Systems • Age-Related Objectives • Number of Objectives Increased

14. The Year 2000 profile of the American people • grew about 7% to nearly 250 million • grew older with a mean age of >36 yrs as compared to 29 yrs in 1975 • Whites shrank from 76 to 72% with Hispanics rose from 8 to 11.3%, Blacks increased from 12.4 to 13.1% • 18 million new jobs were created. Women presented 47% of total work force • American population increased by up to 6 million through immigration

15. Healthy People 2000The Challenge • Increase the span of healthy life • Reduce health disparities • Achieve access to preventive services

16. Healthy People 2010 is grounded in science, built through public consensus, and designed to measure progress.

17. Arthritis, Osteoporosis, and Chronic Back Conditions Access to Quality Health Services Cancer Chronic Kidney Disease Diabetes Disability and Secondary Conditions Educational and Community Based Programs Environmental Health Family Planning Food Safety Health Communication Heart Disease and Stroke HIV Immunization and Infectious Diseases Injury and Violence Prevention Maternal, Infant, and Child Health Medical Product Safety Mental Health and Mental Disorders Nutrition and Overweight Occupational Safety and Health Oral Health Physical Activity and Fitness Public Health Infrastructure Respiratory Diseases Sexually Transmitted Diseases Substance Abuse Tobacco Use Vision and Hearing National health objectives 2010 Healthy People 2010 contains 467 objectives to improve health, organized into 28 focus areas.

18. The Goals of Healthy People • Increase quality and years of healthy life. • Life Expectancy, Quality of Life • Achieving a Longer and Healthier Life—the Healthy People Perspective • Eliminate health disparities. • Gender, Race and Ethnicity, Income and Education, Disability, Geographic Location, Sexual Orientation • Achieving Equity—The Healthy People Perspective

19. Healthy People in Healthy Communities A Systematic Approach to Health Improvement

20. 2002 Institute of Medicine Report • The Future of the Public's Health in the 21st Century • Educating Public Health Professionals for the 21st Century

21. Major Findings of the IOM Study • Public Health law outdated • Public health workers lack training • Communities passive service recipients • Health care fragmented and inefficient • Health communication underutilized • Worksite health needs strengthening • Community based research overlooked

22. The Future of the Public's Health in the 21st Century: Action Steps • Adopting a population health approach that considers the multiple determinants of health; • Strengthening the governmental public health infrastructure, which forms the backbone of the public health system; • Building a new generation of intersectoral partnerships that also draw on the perspectives and resources of diverse communities and actively engage them in health action; • Developing systems of accountability to assure the quality and availability of public health services; • Making evidence the foundation of decision making and the measure of success; and • Enhancing and facilitating communication within the public health system (e.g., among all levels of the governmental public health infrastructure and between public health professionals and community members).

25. 21st Century Public Health Challenges: •Globalization • Scientific and medical Advances • Demographic transformations

26. Education in Schools of Public Health: Eight New Content Areas – Informatics – Genomics – Communication – Cultural competency – Community-based participatory research (CBPR) – Global health – Policy and law – Ethics

36. Social Ecology Model • A Planning/analytical model • Build a big-picture vision • Account for multi-layer interaction of public health practices: intra-personal – inter-personal – organizational - community - societal influences

37. Government is facing SARS crisis Suspected Community SARS Contamination Community cleared of SARS Suspected Hospital SARS Contamination Hospital cleared of SARS & open for full operation • Support prevention policy • Free of family infection • Recover from infection • Recover from bereavement  Suspected SARS Family • No infection • Not to infect others • Cured without implication • Cured with mild implication • Avoid death Suspected SARS Patient An Ecological Model Based SARS Prevention and Control Program Analysis • National SARS control strategy & policy • International collaboration & support • National SARS control center • SARS policy implementation & law enforcement Government prevent & control SARS epidemic effectively Policy Level • Community quarantine strategy • Source detection and isolation • Health and welfare support • Lay-Health Advisors training & organization • Health communication & education • Environmental control & clean up Community Level • Hospital quarantine strategy • Source Detection and isolation • Patient treatment & education • Health worker protection & support • Health communication & education • Hospital environmental clean up Hospital Level • Home quarantine & surveillance • Home health & welfare management • Electronic & non-electronic educational support Family Level • Diagnosis and treatment • Quarantine • Patient counseling • Patient education Individual Level DESIRE OUTCOME INITIAL CONDITION PROGRAM INTERVENTION

39. 125 Years of APHA • Represent 50,000 members from over 50 occupations of public health • Executive Office, Executive Board, Governing Council, American Journal of Public Health, Nation’s Health, <www. apha. org> • Concerned with federal and state health funding, pollution control, chronic and infectious diseases, smoke-free society, and professional education in public health.

40. Major Sections in APHA • Public Health Education and Health Promotion • Health Administration • Medical Care • Public Health Nursing • Epidemiology • Maternal and Child Health • International Health

41. APHA Sections & Special Interest Groups Sections (1/3) Alcohol, Tobacco, and Other Drugs- Promotes public health policy approaches to prevention and treatment of alcohol, tobacco and other drug problems at all levels. Chiropractic Health Care- Serves as a vehicle for chiropractic participation in mainstream public health activities and works to enhance chiropractic communications, education and credibility on public health matters. Community Health Planning and Policy Development- Influences the design of health systems and policies that are responsive to a changing society, by bringing together technical information and the expertise of communities, health professionals, business, and government. Environment- Works to focus attention on human health effects of environmental factors; helps to shape national environmental health and protection policies. Epidemiology- Promotes epidemiological activities; determines optimal immunization policies; analyzes utility of various approaches to disease prevention. Food and Nutrition- Contributes to long range planning in food, nutrition and health policy which affects the nutritional well-being of the public. Gerontological Health- Works to focus the health system on the need for long-term care, hospices, and treatment for the elderly; educates public health professionals about gerontological issues. Health Administration- Concentrates on improvement of health service administration, including cost-benefit and operations research, program activities, finances,standards, and monitoring the organization of health services.

42. APHA Sections & Special Interest Groups Sections (2/3) HIV/AIDS- Provides a professional base for members of diverse disciplines to combine talents and interests to help in the struggle with the HIV-AIDS pandemic; provides leadership to members on HIV-AIDS issues and needs. Injury Control and Emergency Health Services- Serves as a forum for professionals committed to the control of injuries and the delivery of emergency health care; addresses both intentional and unintentional injuries for all age groups and encompasses research, education, training, and practice. International Health- Acts as a focal point for APHA international health activities; encourages consideration of international issues in APHA activities. Maternal and Child Health- Contributes to policy development in adolescent health, child advocacy, injury prevention, family violence, and perinatal care; keeps members current on related issues. Medical Care- Encourages research, analysis, and policy development on organization, financing, and delivery of medical care; strives for an affordable, accessible system of high quality. Mental Health- Promotes public health policy and educational programs dedicated to enhancing the mental health of all persons and to improving the quality of health care for the mentally ill. Occupational Health and Safety- Strives to promote a healthy and safe working environment by organizing around current issues; contributes to policy development regarding occupational health and safety. Oral Health- Promotes the importance of oral health and increasing the public's access to oral health preventive and treatment services; monitors and communicates the oral health needs of the public. Podiatric Health-Advocates a national, preventive foot health strategy; ensures consideration of podiatric concerns in the formation of public health policy.

43. APHA Sections & Special Interest Groups Sections (3/3) Population, Family Planning & Reproductive Health- Addresses issues involving population, family planning, and reproductive health; seeks to ensure that these issues and services remain major domestic and international priorities. Public Health Education and Health Promotion- Promotes the advancement of the health promotion and education profession and provides a forum for public health educators and those involved in health promotion activities to discuss ideas, research, and training; promotes activities related to training public health professionals. Public Health Nursing- Advances this specialty through leadership in the development of public health nursing practice and research; assures consideration of nursing concerns by providing mechanisms for interdisciplinary nursing collaboration in public health policy and program endeavors. School Health Education and Services- Focuses on development and improvement of health services, health education programs, and environmental conditions in schools, colleges, and early childhood care settings; advances public health in all school settings. Social Work- Establishes standards for social work in health care settings; contributes to the development of public health social work practice and research; promotes social work programs in the public health field. Statistics-Develops and designs effective, uniform statistical programs and studies for recognition, analysis, and solution of emerging health problems and needs. Vision Care- Promotes recognition of the need for an effective, equitable, and affordable vision care system for the public; advises on organization, delivery, and financing of vision care services.

44. APHA Caucuses • Academic Public Health Caucus • American Indian, Alaska Native & Native Hawaiian Caucus • Asian Pacific Islander Caucus • Black Caucus of Health Workers • Community-Based Public Health Caucus • Health Equity and Public Hospital Caucus • Caucus on Homelessness • Labor Caucus • Latino Caucus • Lesbian, Gay, Bisexual & Transgender Caucus of Public Health Workers • Peace Caucus • Caucus on Public Health and the Faith Community • Public Health Student Caucus • Caucus on Refugee and Immigrant Health • Socialist Caucus • Spirit of 1848 Caucus • Vietnam Caucus • Women's Caucus • Staff Liaison

45. Caucus of Asian American Health Workers (Asian American Caucus) • Founded 1976 in New Orleans APAH Annual Meeting • President, Executive Committee • APHA Scientific Sessions • Call for abstracts • Speak for the cause of Asian American health needs

47. A Review of the Needs • System approach to health improvement • Capacity/infrastructure building • A social-ecological planning/evaluation strategy • Meet the challenge of 21st century

48. Healthy People in Healthy Communities A Systematic Approach to Health Improvement Successful community partnerships use a systematic approach to health improvement.

50. Government is facing SARS crisis Suspected Community SARS Contamination Community cleared of SARS Suspected Hospital SARS Contamination Hospital cleared of SARS & open for full operation • Support prevention policy • Free of family infection • Recover from infection • Recover from bereavement  Suspected SARS Family • No infection • Not to infect others • Cured without implication • Cured with mild implication • Avoid death Suspected SARS Patient An Ecological Model Based SARS Prevention and Control Program Analysis • National SARS control strategy & policy • International collaboration & support • National SARS control center • SARS policy implementation & law enforcement Government prevent & control SARS epidemic effectively Policy Level • Community quarantine strategy • Source detection and isolation • Health and welfare support • Lay-Health Advisors training & organization • Health communication & education • Environmental control & clean up Community Level • Hospital quarantine strategy • Source Detection and isolation • Patient treatment & education • Health worker protection & support • Health communication & education • Hospital environmental clean up Hospital Level • Home quarantine & surveillance • Home health & welfare management • Electronic & non-electronic educational support Family Level • Diagnosis and treatment • Quarantine • Patient counseling • Patient education Individual Level DESIRE OUTCOME INITIAL CONDITION PROGRAM INTERVENTION