AN OUNCE OF PREVENTION A POUND OF CURE Ben Franklin

1. AN OUNCE OF PREVENTIONA POUND OF CUREBen Franklin VIRGINIA A PUBLIC HEALTH OVERVIEW By Katrina Reeves 15 August 2011

2. Overview Public Health Achievements What is Public Health? Public Health’s Mission Core Functions

3. PUBLIC HEALTH ACHIEVMENTS • According to The Virginia Department of Public Health vaccination are among the top achievements in public health next are: • Maternal and Fetal Health • Emergency Preparedness Virginia Department of Public Health

4. WHAT IS PUBLIC HEALTH? • The Science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts fir the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health. (Schneider, p.5)

5. HISTORICAL PUBLIC HEALTH FIGURES Dr. John Snow Father of Epidemiology Louis Pasteur Father of Microbiology

6. MISSION CONTROL and PREVENTION • Primary Prevention • Secondary Prevention • Tertiary Prevention (Schneider, p.?) • Public health preventions are designed to interrupt the chain of causation that leads to illness or injury

7. CORE FUNCTIONS OF PUBLIC HEALTH • (1) Assessment • Monitor health status to identify community health issues • Identify, Diagnose, and investigate health issues and community health hazards • (2) Policy Development • Inform, educate, and empower people about health issues • Involve the community to both identify and solve health issues • Develop plans and polices that support health efforts at the individual and community level. (Schneider p, 6)

8. CORE FUNCTIONS OF PUBLIC HEALTH • (3) Assurance • Enforce laws and regulations that protect health and safety • Link people to healthcare services when it services would otherwise be unavailable • Provide assurance for a competent public health workforce. (Schneider, p.6) • Goal into Continual research into new insights and innovative solutions for health problems.

9. EPIDEMILOGY The Basic Science Behind Public Health

10. WHAT IS EPIDEMIOLOGY?Click link (Epidemiology Basics, 2011)

11. EPIDEMIOLOGY DEFINED • Epidemiology is the study of the distribution and determinants of disease frequency in human populations. • Frequency=the number of new cases in a population at risk, • Incidence rate= the number of new cases in an at risk population over time. • Prevalence rate= the number of existing cases in a defined population at a single point in time.

12. EPIDEMIOLOGY • Epidemiology fulfills the assessment function of public health • Who? Where? When? • Counts the number of cases of a diseases to detect if there is an epidemic • Reportable diseases are mostly infectious Examples: • Syphilis, hepatitis, measles, Tb,some birth defects (Schneider, p.49)

13. TYPES OF EPIDEMIOLOGY STUDIES • Intervention Studies • Cohort Studies • Case Control Studies

14. EPIDEMILOGY AT WORK Legionnaire's Disease • The American Legion had a convention in July 1976. In August 150 cases of the disease and 20 deaths had been reported to the Pennsylvania Department of Health who notified the CDC. • An investigation was conducted and determined that the members stayed at four different hotels however, the people who stayed at the Bellevue Strafford Hotel higher rates of illness than those who stayed at other hotels. Therefore, the site of exposure was the Bellevue Stratford Hotel. • It was determined that the cause of this disease was airborne. (Schneider)

15. Commonwealth of Virginia department of public Health Structure Workforce Public Health Struggles Infectious Disease Programs Chronic Disease Programs

16. Virginia Fast Facts Virginia rankings... • top 15 states for refugee resettlement • top 10 states with the largest immigrant resident population • top 10 states for intended residence of new arrivals Source: (Virginia Department of Public Health, 2011) Virginia trends... • between 1990 – 2006 the Asian population more than doubled • between 2000 – 2006 the Hispanic population almost tripled • the number of students receiving English as a Second Language (ESL) through Virginia public schools more than doubled (from 36,799 to 78,216)

17. PUBLIC HEALTH CHALLENGES • Virginia Department of Public Health has undertaken the following challenges: • Multi-Cultural Health Care • Focus on its aging Population • Chronic disease prevention • Teen Pregnancy • Immunizations • Injury Prevention • Emergency Management • Regulation of healthcare facilities Source: (Virginia Department of Public Health, 2011)

18. TEEN PREGNANCY used with permission under the fair use policy CDC

19. TEEN PREGNACY • 2009 regional data from the Virginia Department of Health shows that the Southside (61.8) and Hampton Roads (57.6) regions had the highest teen pregnancy rates per 1,000 females between the ages of 15 and 19. • Northern Virginia (31.5) and Valley (38.1) regions had the lowest rates. • In 2009 there were 12,283 pregnancies reported among teenagers in Virginia overall, or 45.5 per 1,000 females aged 15 to 19.

20. AGING POPULATION • In 1990, older women outnumbered older men in Virginia by almost 42 percent. As a result of improving survival rates and increased life expectancies for older men, by 2025 older Virginian women are expected to outnumber older men by only 18 percent. (Virginia Department of Public Health, 2011) Table used with permission from VDH

21. AGING POPULATION • The population of Virginians age 60 and over will grow from 14.7 percent of the total population in 1990 to almost 25 percent by 2025 when there will be more than 2 million Virginians in this age group. • The number of Virginians age 85 and older will increase dramatically between 1990 and 2025 – five times faster than the state’s total population growth. • Virginia's older population is growing more racially and ethnically diverse, reflecting the growing racial and cultural diversity of the Commonwealth and the nation. (Virginia Department of Public Health, 2011)

22. INFECTIOUS DISEASEPROGRAMS IN VIRGINIA • HIV care services to persons living with HIV/AIDS in Virginia since 1991. • It provides AIDS medications to persons who are not on Medicaid or Medicare, and have no health insurance. • Services are targeted to deliver medical care and support services, prioritizing women, children, and infants with HIV/AIDS. HIV/AIDS CLINIC STD SCREENING STATE PHARMACEUTICAL PROGRAM VIRAL HEPATITIS SYPHLLIS ERADICATION

23. INFECTIOUS DISEASE • Public health measures to control the spread of disease are aimed at interrupting the chain of infection at the most vulnerable link. Schneider, 138

24. 35 HEALTH DISTRICTS Minority Health Rural Health Health Mothers and Babies Infant Mortality Violence Prevention Health Statistics Epidemiology Emergency Preparedness Chronic Disease Prevention Infectious Disease Control Environmental Protection Dental Policy Administrative Offices (Virginia Department of Public Health, 2011)

25. WORKFORCE COMPOSITION (Virginia Department of Public Health, 2011)

26. HOW VIRGINIA MEASURES (Virginia Performs, 2011) Graph reused with permission from CDC under the Fair Use Policy

27. WORKFORCE COMPOSITION • Administrators • Public Health Nurses/Educators • Attorneys • Physicians, Dentists, Allied Health Workers • Social Scientists • Case Managers

28. DATA COLLECTION • Data is collected from local, state, and federal authorities the data collected consists of: • Demographics • Ethnicity • Race • Income Levels • Primary Language (Virginia Department of Public Health, 2011)

29. HOW DATA IS USED Virginia uses the system to: • Justify and develop grant proposals for CDC programs and federal block grants using data on diabetes, cardiovascular disease prevention, dental health, nutrition, tobacco use control, and physical activity. • Assist health districts in identifying the need for health interventions. • Support health districts in monitoring the effectiveness of intervention and prevention programs. • Disseminate data used to measure progress toward state and local health objectives. • Develop and promote a statewide breast and cervical cancer control and prevention plan. • Measure progress in identifying resources to help eliminate racial and ethnic disparities in health status. (Centers for Disease Control and Prevention, 2011)

30. CHRONIC DISEASE What is Chronic Disease? A disease marked by long duration or frequent recurrence, usually incurable but not immediately fatal. Examples: Alzheimer's Diabetes AIDS CANCER (Schneider)

31. CHRONIC DISEASE • The Price Tag $$$$ • Cancer $89 billion (2007) • Smoking $96 billion (2007) • Diabetes $116 billion (2004) • Obesity $61 billion (2000) (Centers for Disease Control and Prevention, 2011)

32. MEASURING THE HEALTH OF VIRGINIANS (Centers for Disease Control and Prevention, 2008) Graph reused with permission from CDC under the Fair Use Policy

33. FAST FACTSCHRONIC DISEASE • 7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year. • In 2005, 133 million Americans – almost 1 out of every 2 adults had at least one chronic illness. • Obesity has become a major health concern. 1 in every 3 adults is obese and almost 1 in 5 youth between the ages of 6 and 19 is obese. • Diabetes continues to be the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness among adults, aged 20-74. (Centers for Disease Control and Prevention, 2011)

34. CHRONIC DISEASE MANAGEMENT PROGRAMS • Diabetes Management • Obesity • Cardiovascular Disease • Arthritis • Stroke Awareness (Virginia Department of Public Health, 2011)

35. PUBLIC LAWS • Whether public health professionals are collecting data, proposing a new health care proposal or attempting to establish a new policy there are federal and state laws that must be adhered too. You can find a list of the applicable laws on the website: vdh.virginia.gov Source: (Virginia Department of Public Health, 2011)

36. GENOMICS AND PUBLIC HEALTH • Genomics plays a role in nine of the 10 causes of death in the U.S., most notably cancer and heart disease. These diseases are partly the result of how genes interact with environmental and behavioral risk factors, such as diet and physical activity. • By studying the relationship between genes, environment, and behaviors, researchers and practitioners can learn why some people get sick, while others do not. • Family health history information can also help to identify people who may have a higher risk for certain diseases (Virginia Department of Public Health, 2011)

37. MANDATORYNEWBORN CORE PANEL • Argininosuccinic acidemia (ASA) • Beta-Ketothiolase deficiency (ßKT) • Biotinidasedeficiency (BIOT) • Carnitine uptake defect (CUD) • Citrullinemia (CIT) • Congenital adrenal hyperplasia (CAH) • Congenital hypothyroidism (CH) • Cystic fibrosis (CF) • Galactosemia(GALT) • Glutaric acidemia type I (GA I) • Hemoglobin Sickle/Beta-thalassemia (Hb S/ßTh) • Hemoglobin Sickle/C disease (Hb S/C) • Homocystinuria (HCY) • Isovaleric acidemia (IVA) • Long chain hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) • Maple syrup urine disease (MSUD) • Medium-chain acyl-CoA dehydrogenase deficiency (MCAD) • Methylmalonic acidemia (mutase deficiency) (MUT) • Methylmalonic acidemia (Cbl A,B); • Multiple carboxylase deficiency (MCD) • Phenylketonuria (PKU); • Propionic acidemia (PROP); • Sickle cell anemia (Hb SS disease) (Hb SS); • Tyrosinemia type I (TYR I); • Trifunctional protein deficiency (TFP); • Very long-chain acyl-CoA dehydrogenase deficiency (VLCAD); • 3-hydroxy 3-methyl glutaricaciduria (HMG), and • 3-Methylcrotonyl-CoA carboxylase deficiency (3MCC) (Virginia Department of Public Health, 2011)

38. PUBLIC HEALTH AND GENOMICS • Newborn screening and genetics in public health seek to build programs to implement projects in the following areas: • Needs assessment for State newborn screening programs, genetics programs, and service systems • Integration of newborn screening and genetic services for newborns and children who have, or are at risk of having, heritable disorders into existing State systems of care, which are networks of services and supports that meet the diverse and changing needs of mothers, children, and families, including those with special health needs • Evaluation of new technologies, such as the use of tandem mass spectrometry and DNA-based technologies, for diagnosis and in screening programs • Development of guidelines for genetic and newborn screening services and uniform State newborn screening program standards (Virginia Department of Public Health, 2011)

39. CONCLUSION • Public Health is the heart of today’s society; without public health interventions we as society would not be able to enjoy the extended quality of life that is now enjoyed by Americans such as the increase in average life expectancy and the development of vaccinations for the control and prevention of infectious disease.

40. YOUR TIME AND CONSIDERATION ARE MUCH APPRECIATED End Presentation

41. References • Barker, T. John Snow. A portrait of John Snow. Royal Academy London, London. • Centers for Disease Control and Prevention. (2011). Chronic Diseases and Health Promotion. Retrieved August 11, 2011, from CDC: http://www.vda.virginia.gov/pdfdocs/2624-DeptofHealth.pdf • Centers for Disease Control and Prevention. (1999, April 2). MMWR Weekly. Retrieved August 7, 2011, from Ten Great Public Health Achievements , United States, 1900-1999 : http://www.cdc.gov/mmwr//preview/mmwrhtml/00056796.htm • Centers for Disease Control and Prevention. (2011). MMWR Weekly Report. Retrieved August 8, 2011, from State Health Departments: Eastern States: http://www.cdc.gov/mmwr/international/eastern.html • Centers for Disease Control and Prevention. (2008). Virginia: Burden of Chronic Diseases. Retrieved August 11, 2011, from CDC: http://www.cdc.gov/chronicdisease/states/pdf/virginia.pdf • Epidemiology Basics. (2011). Video Jug Get Fit For Life . California: Friss, Robert Dr.

42. References • Barker, T. John Snow. A portrait of John Snow. Royal Academy London, London. • Centers for Disease Control and Prevention. (2011). Chronic Diseases and Health Promotion. Retrieved August 11, 2011, from CDC: http://www.vda.virginia.gov/pdfdocs/2624-DeptofHealth.pdf • Centers for Disease Control and Prevention. (1999, April 2). MMWR Weekly. Retrieved August 7, 2011, from Ten Great Public Health Achievements , United States, 1900-1999 : http://www.cdc.gov/mmwr//preview/mmwrhtml/00056796.htm • Centers for Disease Control and Prevention. (2011). MMWR Weekly Report. Retrieved August 8, 2011, from State Health Departments: Eastern States: http://www.cdc.gov/mmwr/international/eastern.html • Centers for Disease Control and Prevention. (2008). Virginia: Burden of Chronic Diseases. Retrieved August 11, 2011, from CDC: http://www.cdc.gov/chronicdisease/states/pdf/virginia.pdf • Epidemiology Basics. (2011). Video Jug Get Fit For Life . California: Friss, Robert Dr. • Google. Virginia Map. Commonwealth of Virginia. Google Images. • Hayanga, A. J. (2007). The Broad Street Pump: A Paradigm. Journal of College of Surgeons , e2. • Health, V. D. (n.d.). Vaccines Ranked in Top Ten Great Public Health Achievements - 2001-2011. Retrieved August 15, 2011, from Project Immunization Virginia: http://www.immunizeva.org/news/2011/5/19/vaccines_ranked_in_top_ten_great_public_health_achievements_20012011/ • Health, V. D. (2011). VDH. Retrieved August 11, 2011, from Virginia Department of Health – Progress Report: http://www.vda.virginia.gov/pdfdocs/2624-DeptofHealth.pdf • Unknown. Dr. Robert Gallo. Google Images, Norfolk. • Unknown. Photo, Pasteur, Louis. 14 Predictions By Nostradamus, The Greatest Analyst Ever. Business Insider, Unknown, Norfolk. • Virginia Department of Public Health. (2011). Class Act Virginia. Retrieved August 11, 2011, from VDH: http://www.vdh.virginia.gov/ohpp/CLASact/default.aspx • Virginia Performs. (2011). Retrieved August 12, 2011, from Virginia.gov: http://vaperforms.virginia.gov/indicators/publicsafety/emergencyPreparedness.php