Public Health 101 – An Introduction for Public Health Stakeholders

1. Public Health 101 2009 NACCHO/APC Road Show Public Health 101 – An Introduction for Public Health Stakeholders Presented by Southwest Center for Advanced Public Health Practice Tarrant County Public Health, TX 2009

2. Course Objectives • Identify the basic roles and responsibilities of a local public health agency • Discuss the importance of collaboration between public health and its stakeholders in the event of an emergency • Provide examples of events that are within the scope of public health preparedness • Explain and demonstrate how public health utilizes ICS during emergencies • Describe several of the main steps in an outbreak investigation • List scenarios where public health and first responders are most likely to interface

3. Course Outline • Introduction to Public Health • Public Health Preparedness • Incident Command System (ICS) • Public Health Response to Emergencies • Strategic National Stockpile (SNS) • Introduction to Epidemiology • Isolation and Quarantine • Case Study: Avian Influenza Outbreak

4. What is Health? • Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.

5. Public Health vs. Medicine

6. Public Health Objectives • Prevent epidemics and the spread of disease • Protect against environmental hazards • Prevent injuries • Promote and encourage healthy behaviors • Respond to disasters and assist communities in recovery • Assure the quality and accessibility of health services … derived from American Public Health Association, Ten Essential Services

7. Typical Menu of Public Health Services • Personal Health Services (clinical services) • Immunizations • STD/HIV testing and counseling • Chronic disease counseling • Tuberculosis services • Family planning and maternal & child health services • Travel health services BUT…providing direct clinical services is only one part of the mission of a local health department

8. Population BasedPublic Health Services • Environmental Health • Infectious Disease Control and Investigation • Laboratory Services • Health Education Services

9. The Public Health System Federal Agencies State Agencies Local Agencies

10. Public Health’s Many Partners Police Home Health EMS Churches Community Centers MCOs Corrections Health Department Parks Schools Elected Officials Hospitals Mass Transit Doctors Nursing Homes Philanthropist Environmental Health Civic Groups CHCs Fire Tribal Health Laboratory Facilities Drug Treatment Economic Development Mental Health Employers

11. Which level of government is responsible for protecting public health? • 10th Amendment to the U.S. Constitution: • All powers not delegated to the Federal government shall be reserved for the state governments • States are responsible for protecting public health

12. What is Public Health Preparedness? “Plans, procedures, policies, training, and equipment necessary to maximize the ability to prevent, respond and recover from major events.” (HSPD-21)

13. Public Health PreparednessBuilds Infrastructure for: Everyday health threats Infectious & foodborne diseases Public Health Emergencies Bioterrorism, pandemics

14. Preparedness and Bioterrorism What is bioterrorism??? -- The use of... • Bacteria • Viruses • Parasites • Their by-products …in a terrorist act.

15. Preparedness and Bioterrorism • Possible agents of bioterrorism • Anthrax • Smallpox • Plague • Botulism

16. Preparedness and Bioterrorism • What might an attack of bioterrorism look like? • Not necessarily explosions or plumes of smoke • May not be readily apparent and detectable • Sick people arrive at hospitals or doctors’ offices • Delayed recognition and diagnosis • Population panic

17. Roles in Preparedness • Planning • Coordination/Collaboration • Training and Exercise • Response • Evaluation and Corrective Action Collaboration is critical to success!

18. Roles in Preparedness Situation Examples: • Outbreaks from contaminated food or water, infectious diseases, etc. • Natural disasters: hurricanes, floods, fires

19. Roles in Preparedness • Examples of public health job roles: • Health threats investigator • Public service/media • Post-event tracking • Environmental investigators

20. Incident Command System • Allows a more effective, efficient response to emergencies • Examples: • HazMat incidents • Terrorist incidents • Natural disasters • Incidents involving multiple casualties

21. Incident Command & Public Health • In the event of a public health emergency the public health director will interact with the local EOC or incident command post. • The public health Department of Operations Center (DOC) may be activated to facilitate tactical communications.

22. Public Health Responding to Emergencies • In what type events would you expect Public Health to assume lead role for providing health and medical services ?

23. Public Health Preparedness Summary • Build public health infrastructure to respond to threats from: • Bioterrorism • Natural disasters & disease outbreaks • Requires collaboration between agencies: • Planning • Training & exercises • Response • Communication • Management of resources

24. Strategic National Stockpile

25. Strategic National Stockpile (SNS) • A national stockpile available in the event of a major terrorist attack against the civilian US population • National repository consisting of: • Pharmaceuticals (i.e., antibiotics and vaccines) • Antidotes and antitoxins • Medical and surgical supplies

26. Strategic National Stockpile • SNS is a federal asset deployed locally after a major disaster • The governor of the affected state requests deployment of SNS from:

27. Strategic National Stockpile • Delivered within 12 hours of federal decision to deploy SNS assets • 12-hour “Push Package” • Push packages are warehoused in strategically- positioned locations around the US

28. Local Response to Strategic National Stockpile SNS deployment is a large-scale event requiring adequate: • Security Pre–determined Points of Distribution • Crowd control • Traffic control

29. Local Response to Strategic National Stockpile • Essential that First Responders and others in contact with exposed civilians are the first to be medicated

30. Local Response to Strategic National Stockpile • Must prepare to dispense medicine to a large number of people in a relatively short time span

31. Local Response to Strategic National Stockpile • Expect to work with Public Health: • Work collaboratively • Implement emergency response according to prior planning • Have conducted prior training and exercises • Interagency Cross-Training

32. Epidemiology

33. What is Epidemiology? Study of the spread and causes of diseases or events in specified populations, and the control of health problems.

34. Epidemiology concerned with OUTBREAKS • An adverse health event involving an unusual increase in cases among a certain population of individuals, within a certain period of time, in a certain location

35. Infectious diseases Environmental Behavioral Forensic Disaster Areas of Epidemiology

36. Key Elements in Epidemiology • Person • Place • Time

37. Epidemiology Study Examples(risk or exposure outcome) • Smoking (exposure) increases the risk of developing Lung Cancer (outcome)

38. Epidemiology Study Examples(risk or exposure outcome) • Eating undercooked hamburger (exposure) increases the risk of infection with the bacteria E. coli (outcome).

39. Epidemiology Study Examples(risk or exposure outcome) • Getting a flu shot (exposure) decreases the risk of becoming ill with the flu (outcome).

40. Simplified Steps in an Outbreak Investigation • Confirm outbreak and verify diagnosis • Perform field work and complete study • Implement control and prevention measures • Communicate findings

41. Disease Reporting: Notifiable Diseases • Healthcare providers are required by law to report patients with certain diseases and conditions: • Report immediately (in most states) • Potential BT agents (anthrax, smallpox, plague) • Botulism (foodborne) • Viral hemorrhagic fever, including Ebola • Other selected contagious serious diseases that may affect children and immune compromised or un-protected victims

42. Isolation and Quarantine Protocol

43. History of Quarantine • In the fourteenth century, to protect cities from plague epidemics, ships arriving in Venice from infected ports had to sit at anchor for forty days before landing. • “Quarantine” is derived from the Latin word quaresma, meaning forty.

44. Definitions:

45. Isolation: • The separation of someone who’s infected or contaminated from others so that the infection or contamination is not spread

46. Quarantine • Limitation of freedom of movement of a well person who’s been exposed to an infectious agent

47. What Does it Mean to be Isolated or Quarantined? • No contact with any new people • Can not leave home or place of containment • For evaluation and verification purposes patient needs to check in with Public Health every day

48. What is Voluntary Compliance? • Voluntary compliance with isolation, quarantine or other control measures means a patient cooperates and complies with Public Health’s instructions to comply with the recommended control measures in order to prevent the spread of disease.

49. What is Involuntary Detention? • This is what Public Health will pursue if an individual does not voluntarily comply with an ordered control measure.

50. To What or Who Can “Control Measures” be Imposed? • Person (s) • Groups (5 or more individuals) • Area (city block, ZIP code, county) • Buildings (hospital, hotel, business)* • Common Carrier (plane, bus, train)*