What Exactly is Public Health? Some Multiple Perspectives

1. What Exactly is Public Health? Some Multiple Perspectives Gary D. Gilmore, MPH, Ph.D., CHES Ayaz M. Samadani, MD, DCH, DTM&H Julie Willems Van Dijk, RN, MSN, Ph.D. Bevan K. Baker, FACHE Thomas L. Sieger August 8, 2008 Wisconsin Public Health Council Wisconsin Medical Society Madison, WI

2. Multiple Perspectives about Public Health: Challenges, Opportunities, Success Stories • Overview: Gary D. Gilmore, MPH, Ph.D., CHES • Professor and Director, Graduate Community Health Programs • University of Wisconsin at La Crosse • Vice Chair, Wisconsin Public Health Council • Physician’s Perspective:Ayaz Samadani, MD, DCH, DTM&H • Family Practice Physician • Chair, Wisconsin Public Health Council • Rural/Smaller Municipality Perspective: Julie Willems Van Dijk, RN, MSN, Ph.D. • Health Officer Marathon County Health Department • Chair, Ad Hoc Finance Committee • Urban Perspective: Bevan Baker, FACHE • Commissioner of Health, City of Milwaukee • Chair, Emergency Preparedness Committee • Statewide Perspective: Thomas L. Sieger • Deputy Administrator • Wisconsin Division of Public Health

3. Overview Public Health: • A shared responsibility for community well-being through ongoing assessment, advocacy, and assurance. • The combination of science, practical skills, and values (or beliefs) directed at the maintenance and improvement of the health of all people. Sources: J. Last. Public Health and Human Ecology. 1998. C.G. Sheps. Higher Education for Public Health. 1976.

4. Determinants of Population Health SOURCE: The Future of the Public’s Health (IOM 2003).

5. Vision:Healthy People in Healthy CommunitiesMission:Promote Physical and Mental Health & Prevent Disease, Injury, & Disability • Public Health • Prevents epidemics and the spread of disease • Protects against environmental hazards • Prevents injuries • Promotes and encourages healthy behaviors • Responds to disasters and assists communities in recovery • Assures the quality and accessibility of health services

6. Essential Public Health Services • Monitor health status to identify community health problems • Diagnose and investigate health problems and health hazards in the community • Inform, educate, and empower people about health issues • Mobilize community partnerships to identify and solve health problems • Develop policies and plans that support individual and community health efforts • Enforce laws and regulations that protect health and ensure safety • Link people to needed personal health services and assure the provision of health care when otherwise unavailable • Assure a competent public health and personal health care workforce • Evaluate effectiveness, accessibility, and quality of personal and population- based health services • Research for new insights and innovative solutions to health problems Source: Public Health Functions Steering Committee. July, 1995.

7. Source: Public Health Functions Steering Committee. July, 1995.

8. Ten Core Practices of Public Health Assessment 1.Assess the health needs of the community 2. Investigate the occurrence of health effects & health hazards of the community 3.Analyze the determinants of identified health needs Policy Development 4.Advocate for public health, build constituencies & identify resources in the community 5.Set priorities among health needs 6.Develop plans & policies to address priority health needs Assurance 7.Manage resources & develop organizational structure 8.Implement programs 9.Evaluate programs & provide quality assurance 10. Inform & educate the public Source: Dyal, WW. American Journal of Preventive Medicine. 1995;11 (6 suppl):6-8.

9. Public Healthin relation toHealth Services A Critical Balance What Exactly is Public Health? Physician’s Perspective Ayaz M.Samadani M.D., DCH., DTM&H Family Practice Physician Chair, Wisconsin Public Health Council

10. Public Health Components • Epidemiology • Biostatistics • Health Services • Environmental • Social • Behavioral • Occupational Health

11. Relationship • Inter-related • Dependent on each other • Medical Services • Education • Research

12. Symptoms Examination Diagnosis Treatment Outcomes & End Results Credible Information Data Management Stock for Policy Development Communication Opportunities withinClinical Encounters

13. Policy Development Protecting Health & Safety of population Training of Providers Developing Network of partnerships Outcomes Maternal Care Successes Tobacco Immunization Opportunities Policy Development Improved Care Well trained work force Improved Education Satisfied Population

14. Providers Doctors RNS NP PA MA Chiropractors Podiatrist Nutritionist Physiotherapist Work Force Issue Infectious Diseases Preventive Care Chronic Disease Management Patient Education Web services Volunteer Groups Obesity Pandemic Partnership & Collaboration

15. Communication Funding Implementation Education of Partners Education of Providers HMO/PPO Education of Consumers Private pay/uninsured Society/Community responsibilities Governmental bodies Legislature Philanthropists Challenges

16. Disasters Natural Man-made Outbreaks War Apathy Increased demands/Limited Resources Matching Funds for Federal Emergency Funding Special Population Preparedness Access to Mental Health Challenges

17. Tobacco Control Vaccination of Target Population Voluntary National Accreditation Program Decreased demands Increased Cessation Decrease in Second Hand Smoke Exposure Advance Wisconsin as a Smoke Free State Success Story

18. Rural/Smaller Municipality Perspective Julie Willems Van Dijk, RN, MSN, Ph.D. Health Officer, Marathon County Health Department Chair, Ad Hoc Finance Committee

19. Opportunity!! To improve the health of Wisconsin’s people

20. The Three P’s • Prevention • Population • Partners

21. Social Ecological Model • Individual • Family/ Interpersonal • Institutional • Community • Policy

22. Challenges to Rural/Small City Public Health • Root Causes (It’s bigger than behavior.) • Data (Small populations, Fewer Resources, Delayed Timing) • Workforce (Fewer People, Smaller Pool of Professional Preparation, Wage Scales not Competitive) • Financing (See Our Report + 2% Tax Levy Caps + Current Economy)

23. Successes • Community Health Improvement Processes (CHIP) • Public Health Preparedness • Immunization Rates (Marathon Co: 63% to 90% in six years [1995-2001]. Maintained at 90% for ten years) • Adult Smoking Rates (Marathon Co: 35% in early 1990’s; 15% in 2006)

24. Urban Public Health Perspective Bevan K. Baker, FACHE Commissioner of Health, City of Milwaukee Chair, Emergency Preparedness Committee

25. Challenges Budget: -Decreasing tax levy -Increasing reliance in categorical grant’s that don’t support core services City of Milwaukee Health Department,2008 source of revenue Workforce -Need competencies that support population health focus at the same time there is an increasing need for more direct service -Accreditation

26. Income & Social Status Social Support Networks Education and Literacy Employment and Working Conditions Physical Environments Social Environments Personal Health Practices and Coping Skills Health Child Development Biology and Genetics Health Services Gender Culture ChallengeMaking the Upstream Shift to Address Disparities Source: Social Determinants of Health - Public Health Agency of Canada; http://www.phac-aspc.gc.ca/ph-sp/determinants/index.html#determinants

27. Opportunities Teen pregnancy epidemic hurts Milwaukee businesses • The Business Journal of Milwaukee - A single teen pregnancy costs the Milwaukee community nearly $80,000 a year, and those mothers and their children are less likely to finish school, depleting the city's potential work force, according to a study released Thursday.

28. Success:MPS Immunization Rates

29. Key Strategies • Data reconciliation between WIR and MPS data system – including working toward electronic data exchange • Increasing parental awareness of immunization requirements and the immunization status of their children • Increasing access to immunizations through school based immunization clinics • Develop coordinated media and social marketing campaign to improve immunization rates • Assuring compliance with state immunization statute

30. Back to School Marketing • Posters on new requirements • Auto-dialer messaging to parents • Back pack messaging to parents • Distribution of educational materials at health fairs • Radio commercials • Bus tails • MPS Open enrollment clinics • McDonald tray liners

31. Statewide Perspective Thomas L. Sieger Deputy Administrator Wisconsin Division of Public Health

32. What is Public Health? • A social enterprise that is focused on the population as a whole • Organized efforts of society to protect, promote, and restore people's health, to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population.

33. Public Health Successes • Planning - HW 2010 (2020?) • Disease Surveillance - WIR, WEDSS and PHIN • Disease Prevention and Health Promotion - Tobacco use, Pb poisoning, Immunization • Preparedness - Flooding, measles and E. coli in spinach • Public Health Regulation - HFS 196, 172 and others

34. Major Public Health Challenges • Public Health Infrastructure • Public Health Financing • Workforce • Health of the Population • Burden of Chronic Disease • Health Disparities • Social and Economic Determinants of Health

35. Crisis = Danger/Opportunity *Source: "Burdened by healthcare costs. US Businesses seek a shift." The Christian Science Monitor. February 13, 2007

36. Opportunity = Prevention An investment of $10/person/year in evidence based prevention programs could yield an ROI of 6.15/1 over a 5 year period in healthcare savings, or in Wisconsin Total annual investment = $54,990,000 5 Year Net Savings = $337,900,000 Source: Trust for Americas health. 2008. “Prevention for a Healthier America.”

37. We Can Do Better — Improving the Health of the American People The united states spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status. How can this be? What explains this apparent paradox? The two-part answer is deceptively simple first, the pathways to better health do not generally depend on better health care, and second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care. Steven A. Schroeder, M.D.N Engl J Med 2007;357:1221-8.

38. Having a System that Lowers Costs by Helping People be Healthy: Public Health PRICELESS

39. Advocacy Organizations Business & Labor Media Community-Based Health Organizations Faith Community Health Care Providers Civic Organizations Community Health Centers Educators Healthcare Consumers State and Local Public Health Departments Foundations Professional Organizations Managed Care Hospitals & Clinics Community Residents Healthcare Purchasers Colleges, Universities & Technical Schools Law Enforcement DATCP, DNR, DPI and other governmental agencies State & Local Elected Officials

40. Summary • Next Steps • Questions