Foundations of Public Health PH-200 Fall 2009

1. Foundations of Public HealthPH-200 Fall 2009 Integrating Diverse Foundations of Public Health Into Solutions and Sustainable Infrastructures Week 10

2. Outline • 9:30 AM – 9:45 AM : Questions and Review • 9:45 AM – 11:00 AM : Integrating and Translating Theoretical Foundations of Public Health • 11:00 AM – 11:15 AM : Recess • 11:15 AM – 12:15 PM : Proposal Summaries • The Unfulfilled Promise of Public Health • 12:15 PM – 12:30 PM : Summary

3. Pop-quiz • What is the relationship between “demographic transition” and “epidemiologic transition?” • Discuss notable exceptions to the traditional epidemiological transition model. • Research challenges in public health are embedded in the gap between “what is” and “what ought to be.” But what “ought to be” is subject to a variety of ethical considerations. Discuss your understanding of public health ethics.

4. Integrative Models in Public Health • Ecological Model: The health of populations and individuals is influenced by the interaction of biological, environmental, and behavioral factors. The Institute of Medicine recommends the use of the ecological model as the basis for public health education and interventions (IoM, 2003). • Some Schools of Public Health, such as the University of California at Berkeley (UC Berkeley), are using this model as the basis for teaching, research, and community interventions to improve health. The model is the cornerstone of Berkeley’s recently developed strategic plan, along with a commitment to associated interdisciplinary action and social justice to improve public health.

5. Ecological Model (UC Berkeley) Ecological Perspective Interdisciplinary Approach Biology Goal: Improve Human Health Behavior Environment Diversity, Human Rights, Social Justice Movement from Publication to Public Action

6. Healthy People 2010 • Healthy People 2010: Established a national goal of eliminating health disparities by 2010. It recommends that organizations and communities design, implement, and evaluate interventions using a framework that incorporates elements of the ecological model and also includes policy and health care factors.

7. Healthy People 2010 Model Determinants of Health Policies and Interventions Behavior Physical Environment Individual Social Environment Biology Access to Quality Health Care

8. Hierarchical Models: How useful are they? For research? For practice? For education? Social and Economic Policies Culture Organizational Connections (Communities) Socioeconomic Psychosocial - Behavioral Genetics Human Biology Pathological Biomarkers Health and Development Life course

10. Sample Program Logic Model Program and System Supports Early Childhood Development, Learning & Care Pregnancy, Birth, and Infancy --- Parenting & Family Support Providing personal, practical support to parents Training of, consulting with, service providers Evaluating provincial NP services & community impact Ongoing parental awareness media campaigns Developing & implementing service coordination policies, protocols Creating, disseminating child development resource materials Promotional advocacy campaigns Developing networks of service providers Organizing community events ACTIVITIES Providing referral info & hotline Providing professionally led support groups for parents Providing parent education & training Providing parent screening & assessment Provide small learning groups for children Providing counseling to parents Providing child screening & assessment Improved identification of at-risk parents, infants and children (PPD, P4, developmental delay, etc). Increased capacity to assess program planning & effectiveness Increased service provider knowledge of pregnancy & child development supports & services/gaps Increased SP knowledge & skills of pregnancy & child development best practices & interventions Increased service provider collaboration Increased feelings of family & social support Increased child stimulation & interaction Improved parenting knowledge and practices (pre- & postnatal care, nutrition, child development, parenting skills, health/safety) Improved knowledge of supports & services for healthy pregnancy & infant/child development SHORT-TERM OBJECTIVES Increased service provider, parent, & community awareness of the importance of the early years Increased parent & community awareness of pregnancy & child development services Enhancing & expanding core programming Improved emotional functioning & well being of children Increased entry into appropriate supports & services Increased parenting capacity Increased use of other supports & services Increased accessibility of pregnancy & child development intervention programming LONG-TERM OBJECTIVES Increased coordination & integration of services in community Increased general awareness of the importance of parenting Improved child health & physical well-being Increased child prosocial behaviours Improved school readiness Improved infant health & well-being Improved maternal health Increased community participation in EY & prevention activities Increased commitment, support, programming for EY services GOALS Promote children’s optimal development and readiness to learn, so that they may reach their fullest potential Promote Healthy Pregnancy & the Birth of Healthy Babies For all children to be healthy, safe, and secure within strong families and communities Link to Map

11. “Ecological” Model : Patz et al. Environmental Health Perspectives Volume 112, Number 10, July 2004

12. Course Summary • OBJECTIVES: • The graduate “foundations” course is designed for incoming graduate students in professional public health degrees, taking into consideration diverse academic backgrounds and skills. • The course provides an opportunity for students to investigate the fundamental determinants and the complex set of intermediate factors that underpin health and disease status in different populations at various scales of analysis. • After completing the course, students should be knowledgeable about the diversity of conceptual and methodological approaches and academic disciplines which inform public health research and practice. • The course content highlights core competencies and cross‐cutting themes essential for successful public health intervention programs

13. Course Organization • During the first segment, students are introduced to how public health is practiced at the international, nation, regional, and local levels, with presentations drawing from “Milestones in Public Health” a project that highlights historical developments on 10 major causes of morbidity and mortality in human populations (http://www.pfizerpublichealth.com/podcasts.aspx) . • Each student is expected to build on these presentations to develop a scholarly review of current burden of disease at the regional or global level, using concrete examples of how public health core disciplines and cross‐cutting themes are made to work for identifying and solving problems at those scales of analyses. • For this review, students are expected to consult, for example, the World Health Organization’s project on the Global Burden of Disease (http://www.who.int/topics/global_burden_of_disease/en/).

14. Organization..continued • The second requirement is for each student to develop a public health problem‐solving proposal that builds upon our exploration of the theoretical foundations necessitating transdisciplinary approaches in the natural and social sciences and administrative functions in public health. • These theoretical linkages, following exposure to how public health practice is organized in the world, will hopefully prepare students to explore more deeply within the curriculum organized around the core disciplines of biostatistics, epidemiology, environmental health sciences, social and behavioral sciences, and health policy and management. • The final examination will be based on lecture materials.

15. Schedule of Topics • Week 1 – Introduction and orientation to the core and cross-cutting, interdisciplinary approaches in public health. • Milestone: Eradication of Smallpox

16. Week 2 • The real causes of death and disability: The “Global Burden of Disease” project. • Essential Resource: World Health Organization’s (http://www.who.int/topics/global_burden_of_disease/en/) • Milestone: Automotive Safety

17. Week 3 (Public Health and Law Symposium) • Integrative public health research and practice at the national level • Centers for Disease Control and Prevention • Essential Resource: (http://www.cdc.gov/) • Milestone: Environmental Health

18. Week 4 • Integrative public health research and practice at the regional level • California Department of Health Services • Essential Resource:(http://www.dhs.ca.gov/) • Milestone: Infectious Disease Control

19. Week 5 • Integrative public health research and practice at the local level. • Essential Resource; Orange County Health Care Agency (http://www.ochealthinfo.com/) • Milestone: Cancer

20. Week 6 • Week 6 – Scholarly Review • Student Presentations • Milestone: Cardiovascular Disease

21. Week 7 • Theoretical foundations of the transdisciplinary approaches in public health research and practice – The natural sciences. • Milestone: Safer and Healthier Foods

22. Week 8 • Theoretical foundations of the transdisciplinary approach in public health research and practice – The social and behavioral sciences • Milestone: Maternal and Child Health

23. Maternal Mortality

24. Old and New Challenges to M&C H • Since ~ 1982, U.S. Maternal Mortality has reached a plateau at 7 – 8 maternal deaths per 100,000 live births. • Twenty countries have reduced their maternal mortality rates below U.S. levels. • Legalization of induced abortions led to 89% reduction in deaths from septic processes between 1950 and 1973. • Insurance coverage of pre-natal care

25. Infant mortality Per 1,000 live births

26. Infant Mortality Challenges • 100 years ago, 1/6 live births • Today, < 1/100 live births in the U.S. • Low birth-weight • Vaccination / Autism • Sudden Infant Death Syndrome (Ethnic disparities) • Chinese experience with one-child per family, and gender selection. • Genetic Counseling • “Family Planning” and government support at the global level.

27. Population-Level Intervention • Multivitamins and birth defects • (Folic acid/Spinal bifida)

28. Recommended Daily Intake (Folic Acid)

29. Week 10 • Theoretical foundations of the transdisciplinary approach in public health research and practice – Public health administration and intervention program implementation. • Milestone: Oral Health

30. Cancrum oris (Noma)

31. Week 10 • Discussion of Proposals. • Milestone: Addiction • Milestone: Public Health Infrastructure

32. Pop Quiz • What, in your opinion, are the grand challenges for maternal and child health in the world today? • Why is Dentistry a separate profession from Medicine? Is this a “good” or “bad” arrangement for public health? • Where do you stand on the issue of “mandatory” public water fluoridation? Compare California and Michigan. • Where do you stand on the issue of dental mercury amalgams? • Vancouver City established supervised injection sites (Insites) for drug addicts. Where do you stand on this policy?

33. Week 11 • Final Examination • Lecture contents • This room at 10:00 AM on December 11th.

34. Proposal Writing • Scholars Grants in Public Health http://www.promisingminds.com/AwardDetails.aspx?ProgramID=204&PrevGrant=1 • Program Description • These awards are meant to support the career development of junior faculty in public health. This educational grants is nationally competitive, and chosen by an independent Academic Advisory Board of recognized leaders in public health. • Up to $130,000, paid over two years, will be awarded to individuals who are pursuing community-based, public health practice research intended to foster academic science and knowledge of public health, and collaborative partnerships between accredited schools or programs of public health and state and local departments of public health. The proposed research should support the needs of a state or local public health organization. The research should focus on public health practice issues likely to have a demonstrable impact on community health and/or the public health system. • Award funding is primarily intended for salary support. The applicant must demonstrate that at least 75% of his or her professional time will be devoted to research. Proposals involving head-to-head clinical trials or veterinary health will not be considered. Interdisciplinary and translational research proposals are encouraged.

35. Research Proposals • Due in the DropBox, Friday 11th December 2009

36. Grading Criteria • Topical Review Article (4000 words) = 40% • (and exercises) • Proposal Development = 40% • (and exercises) • Final Examination = 20%

37. Proposal Idea Presentations