What Is Public Health?

1. PUBH 8002. A SYNTHESIZED PUBLIC HEALTH STUDIES. 1QTR.WK1-11FINAL PROJECT: NWABUIBE, Collins.docPRESENTATIONNovember 11, 2013 What Is Public Health? Public Health has been described as the science and art of Protecting and improving the health of community through education, promotion of healthy lifestyle, and research for disease and injury prevention. Public Health helps improve the and well-being of people in local communities and around the globe. PH works to prevent health problems before they occur

2. Definitions’ of Public Health Winslow (1920),describes it as “ the science and art of preventing life, and promoting physical health and efficiency through organized community efforts for 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” Turnock (2001), later described public health as the “ collective effort to identify and address the unacceptable and realities that result in preventable and avoidable health outcomes, and it is the composite of efforts and activities carried out by people committed to these ends” Institute of Medicine (1988), offered a condensed definition of public health as “ fulfilling society’s interest in assuring conditions in which people can be healthy, “, WHO , Public Health refers to all organized measures ( whether public or private) to prevent disease, promote health and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases

3. Core Functions of public health The three main functions of public health are The assessment and monitoring the health of communities and populations at risk to identify health problems and priorities The formation of public policies designed to solve identified local and national health problems and priorities To ensure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services.

4. Applications of ph core functions Assessment Policy development Assurance ( e.g. , guidelines and strategies in preventing HIV/AIDS)

5. Brief history of Public Health • During the past 150 years two factors have shaped the modern public health system: first, the growth of scientific knowledge, second, the growth of public acceptance of disease control as their responsibility, • In earlier centuries, little was known about the causes of disease, society tended to regard illness with a degree of resignation and few public action was taken • Public organizations, and agencies were formed to employ newly discovered interventions against health threats • Scientific knowledge grew, public authorities expanded to take on new task i.e. sanitation, immunization, regulation, health education, and personal health care • In 18th century, outbreak of epidemic such as the plaque, cholera, and smallpox evoked sporadic public health effort to protect citizens in the face of dread disease • Isolation and quarantine of the ill became common measures for containing specified contagious disease ( e.g., several American ports cities adopted rules for trade quarantine and isolation of the sick) • In 1601, the practice of public health became official in England following the adoption of Poor Law which continued in American colonies (Grob,1996;Starr, 1982) • The 19th century marked The Great Sanitation Awakening and advance in Public Health and the identification of filth as both a cause and a vehicle for transmission of disease (Winslow, 1923) In the US, • Shattuck (1850), documented vital statistics on Massachusetts population finding differences in morbidity and mortality rates in different localities • Dorothea Dix ( n.d), and others led the movement in the establishment of some 32 public institutions to care for individuals who mentally ill • In the 19th century social reform movement established the principles of state responsibility for the indigent mentally ill ( Grob, 1996; Foley & Sharfstein, 1983)

6. Impact of public health In brief, • The dramatic achievements of public health in the 20th century have improved our quality of life: an increase in life expectancy, worldwide reduction in infant and child mortality, and the elimination or reduction of many communicable diseases • Today, and into the 21st century, PH leaders have strengthened their roles as advocates for improved population-based health in an International and local community • In 1999, the Centers for Disease Control and Prevention named the top ten greatest public health achievement of the 21st century- advances have been made largely responsible for increasing the lifespan of populations; over twenty-five or twenty years can be accredited to public health initiatives, while medical advances account for less than four years. In sum, the average life expectancy for Americans has increased by about 30 years since 1900.

7. Why is public health controversial Introduction-Public health services (interventions) have propensity to be embroiled in controversies, very engrossing and can hardly be settled once and for all to everybody’s satisfaction. The Controversies- People take position when Public Health debate is on, especially among the expert who refuse to part away their stands-on of methods of intervention, application, regulations or management/implementation part of it on human populations ( e.g., structural issues and other factors such as economics, politics, the values of individuals liberty, religion and morals, and cultural context as the key issues) The role of these factors and other structural factors such as stigma and discrimination associated with HIV/AIDS also diminishes public health responses to the (HIV/AIDS vulnerability) development of policies and decision making and response in prevention and control ( Malikhoa, 2006)

8. Public Health Workforce Definition The public health workforce has frequently been defined as those individuals employed by local, state, and Federal government health agencies for the purpose to improve health outcomes by enhancing the training, skills, and performance of public health workers. For purpose of this discussion, individuals in academia who educate, train, or perform research in public health should be considered part of the public health workforce responsible for providing the services identified in the Public Health in America statement regardless of the organization in which they work (Evans & Stoddard, 1994)

9. objectives • Enhance the ability of the public health workforce to improve public health at home and abroad • Strengthen the nation’s humans service workforce • Improve national, state, local and tribal surveillance and epidemiology, laboratory capacity, and support monitoring and evaluation systems that measure HIV prevalence and incidence, behavior change, population health status. Improve national, state, local public health, and human service workforce capacity • To recruit, hire, retain a talented and diverse public health workforce that is representative of the American people health services • Create culture of wellness across public health services by assessing existing onsite health and wellness programs, and develop plans to expand and enhance programs across public health delivery system in the US. ETC,.

10. Other occupations within ph • Health policy & management • Epidemiology • Health communication • Occupational safety & Health, • Environmental Health Science

11. Wk4 Public Health & the Government Introduction • The role of Government in public health in the USs is complex, sometimes difficult to discern, and always determined by legislation at the federal, state, or local levels. Although, health is not defined in the Constitution the states have primary authority, and within the states, local public health agencies have responsibility for day-to-day efforts in providing healthcare services to the need population

12. Gov’t Role • To provide guidelines/framework Analysis for state health departments • Functions • Structure of local Health Department • Policies, regulations, and funds

13. Wk 5. A Review of Fielding & Briss article on: Promoting Evidence-Based PH. Policy & Practice Introduction • The discussion was on how we can integrate scientific base evidence with community evidence-based interventions into community health system to achieve an effective health services, and why it has not been a priority in the US. Having this mind, Fielding & Briss ( 2006) identified scientific base tools available that will help integrate best available information with public health policy and practice; such tools include • the health Impact Assessment • scientific Review • portfolio for assuring community fit, and • feasibility/accessibility

14. Best available Information Fielding & Briss (2006) missed in their article • Fielding & Briss failed to identify the following tools that could have Impacted integration of information in public health policy and practice to promote Evidence-Based concept that ensures effective interventions into Communities, and public health policy and practice. These tools include • Training and planning tools • US health surveillance • Systematic reviews and evidence-based guidelines • Economic evaluation • Gray literature, and above all engaging the Community in Assessment and decision-making, and using data and information gathered from the residence in the community

15. Challenges In Implementing Effective Policies & Practice in Communities • Political Interference • Lack of funding • Skilled personnel • Lack of representation of all population settings and type of methods used in collection of data • Economic context of the affected population • Lack of collaboration between the sectors. Etc.,

16. Did PH Policies & Practice succeed using scientific evidence-base? • YES, • Has provided successful sources of public health recommendations based on systematic reviews as a Guide to Community Preventive services: targeted laws such as smoking bans, child safety seat laws, vaccination requirements for schools, and community-wide policies on water fluoridation. See Appendix i ( % of Ga. population covered by 100% Smokefree Air Law. 2013) • Provided policy makers information to make informed policy decisions to improve the effectiveness of state public health programs and health of the population • Has been used to develop policy strategies, draft legislation, evaluate proposed legislation or monitor program progress • Helped to educate the public on disease prevention through mass media and social marketing • Successful Process evaluation, and Cost-effectiveness evaluation. etc.,

17. Wk6 . A Reviewed MMWR article on Morbidity & Mortality Rates Introduction • The MMWR, a prepared report on Morbidity and Mortality report by the Center for Disease Control and Prevention (CDC). Often called “ The Voice of CDC” • The primary objective • Vehicle for the agencies timely publication of scientific reports on prevention of further spread or transmission of Mycobacterium, tuberculosis, and regimen for preventing diseases in the environment • Recommend early prevention and treatment o diseases in communities and globally • Recommend diagnosis and screening Method Used by MMWR in investigating Disease outbreak such as Tuberculosis (TB), include- Index Patient, and Chest Radiography

18. Wk7 . Disc. Infectious Disease and PH focus In this topic we discussed- A Historic Prevalence and Distribution of Avian A(H7N9) among wild bird According to Olson, et al, (Feb.2013), revealed in their studies of Prevalence and Distribution of Avian Influenza Virus A(H7N9) among Birds in China of infections of the disease, and the researchers identified Chains of Infection and the links in the distribution of the diseases. Also, Chen, et al, (2011), in their studies of the A(H7N9) virus prevalence, after reviewing GenBank data, revealed that humans were infected by domestic birds. The out break of the and the impact on environment and humans were devastating that Public Health officials took notice and began investigation on the pattern or factors that enhances the spread of the infectious disease. According to WHO ( 2012), infectious diseases are emerging more, and prevalence in distribution of influenza virus infections which attracted Public health prevention and control measures (e.g., SARS and Pandemic Influenza in H1N1 in Canada)

19. The Impact • PH focus on infectious diseases trends is to monitor the impact of public health prevention and control measures (e.g., immunization health promotion). Furthermore, public health focus on early detection, monitoring, and carryout investigations to identify the source, including laboratory testing of available, isolation and treatment of the sick (quarantine people to limit spread of diseases), and follow-up with close contacts of the sick

20. Wk 8. Disc.- Preventing Chronic Diseases Introduction • Preventing chronic diseases by PH was a success that led to a change in the major causes of illness and death especially in the US. Despite the multiple causes of Chronic degenerative diseases, through research scientist ( Epidemiologists), and other Public health officials were able to recognize significant risk factors and was able to establish preventive measures to combat the chain links’ from spreading infectious diseases and other related health issues especially among low income populations ( e. g.. New York City’s Health Bucks Program explored and implemented by Public Health in Preventing Chronic Disease developments in humans).

21. Most Effective Measures to Prevent Chronic Diseases These measures include, • Primary Prevention level- is usually aimed at the population as a whole and is considered the most effective preventative health care available (e. g., Immunization are probably the most effective primary prevention of diseases), and/or health education promoting the use of condoms to prevent HIV/AIDS, infections. • Secondary level- disease prevention is in this level is intended for those who have risk factors for developing a disease but not yet have a diagnosis or symptoms. The goals of secondary prevention is to identify, and treat if necessary, those people and catch the disease as early as possible to avoid advanced disease and symptoms' ( e. g., screening test), an excellent secondary level disease prevention • Tertiary – when primary prevention has failed and secondary prevention has done all they can do to improve the patient’s condition, tertiary prevention becomes the means to fight the disease ( e. g., follow-up and monitoring of all regimens, and therapy to help restore individuals’ functions).

22. Wk9 Disc. The Role of Genetics and Genomics in Public HealthShould the Government invest significant Resources on Genomics studies • The role of Genomics in Public Health is to integrate advances in human genetics into Public Health research, policy, and programs. Therefore, is imperative a significant resources is expended in Genomics to enable researchers advance their studies especially in investigating the role of Family history which is extremely important in determining appropriate behavior and care. • There is need to further integration of genetic services and education in Public Health in the US, and in developing countries in which public and private health services are dichotomized- in other words, significant resources is needed to de-dichotomize these services. • Genomic medicine will further enhance core ph functions and essential services ( e. g., from Newborn Screening to DTC Genetic Testing), significant resources spent on integration of Genomics into PH will enhance standards and guidelines, in collaboration with stakeholders in development and promotion of appropriate use of genetic information and the effectiveness, accessibility, and quality of genetic tests and services. • Spending significant resources in Genomics will quarantine quality Assessment, and Assurance, Policy Developments to constituents’ that genetic information is used appropriately, genetic test and services meet the agreed upon goals for effectiveness, accessibility, and affordability of essential services.

23. Percentage Georgia State Population Covered by 100% Smokefree Air LawsOctober 1, 2013 • This table represent Ga. state population covered by 100% smokefree air laws enacted by the state and local municipal public health departments. These ordinances and laws currently in effect. State type % of % of state % of state population % of state population % of state population with . state population population with with 100% smokefree with 100% smokefree any 100% smokefree . of laws with 100% 100% smokefree bar laws non-hospitality laws . laws smokefree restaurant laws workplace & restaurant . non-hospitality & bar laws . workplace laws GA State 0% 0% 0% 0% 0% . GA Local 12% 6.1% 3.5% 2.3% 15.9% . Source: www.no-smoke.org.ann@no-smoke.org

24. In Conclusion • Public Health innovations has helped humans life expectancy especially in the US and globally. Through scientific evidence information researcher provided quality and optimized information that enabled policy makers to provide informed policies and regulations to state and local public health services agency’s. Public health education created awareness to the public preventive measures to combat factors that enables the spread of infectious diseases in humans. Public health innovation provided the strategies in the integration of scientific evidence and Evidence-Based studies in determining the most effective interventions in the treatment of chronic diseases affecting low income populations.

25. References Florida Public Health Review, 2004; 1: 24-29. School Health is Public Health. Retrieved from, http://publichealth.usf.edu/fphr Turnock, (2001), Over View of Public Health “ What Is Public Health” from Essentials of Public Health. Jones & Bartlett Publishers, LLC. Retrieved from, www.jblearning.com/samples/0763738514/38514_ _001_020.pdf WHO ( 2013), Public Health: Trade, foreign policy, diplomacy and health. Retrieved from, www.who.int/trade/glossary/story076/en/ What is Public Health? ( 2004)., Retrieved from, www.whatispublichealth.org/what CDC (1999), Impact of Public Health. In “Turnock, BJ. Public Health: What it is and How it Works, 3rd Edition. Sudbury, MA; Jones Bartlett Publishers, 2004. Retrieved from, www.hatitispublichealth.org/ impact/index.html

26. References cont’ Chave, ( 1998, Fee, 1187) A History of the Public Health. Retrieved from, www.nap.edu/openbook.php? record_id=1091&pag=56 Public Health Core Functions and Community Health Planning; August 1, 2010. Administrative Reference- Volume 1. Retrieved from, chfs.ky.gov/NR/rdonlyres/9B1E384C-40B7-444C-AA4F-7C9916 C77D6C/0/ARVol1PublicHealthCoreFunctionsandCommunityHealthPlanning.pdf Malikhoa, ( 2006), Why Is Public Health Controversial? Retrieved from, samples.jbpub.com/9780763817/J10658_Chapter02.pdf Evans & Stoddard, (1994), The Public Health Workforce: An Agenda For The 21st Century. A report of the Public Health Functions Project; U.S. Department of Health and Human Services. Retrieved from, www.health.gov/phfunctions/pubhlth.pdf CDC: National Center for Chronic Disease Prevention and Health Promotion: Tools for Implementing an Evidence-Based Approaches in Public Health Practice.Pro Chronic Dis 2012,9:110324.DOI: http://dr.doi.org/10.5888/pcd9.110324 Updated July 2012. retrieved from, www.cdc.gov/pcd/issues/ 11_0.324.htm MMWR. Series: Weekly. Vol.6 no.39. Published October 4, 2013 Public Health Agency of Canada Responding to an Infectious Disease Outbreak: Process Between SARS and Pandemic Influenza (H1N1). Date Modfied:2012-4-11. Published Public Health Agency of Canada. www.phac-lasp.gc.ca/ep-mu/rido-icm/index-org.php#tphd

27. References cont’ Recall Bias: An Approach for Assessment and Control: international Journal of Epidemiology, 1987. Retrieved from, http://www.ife.affordjournals.org Published by International journal of Epidemiology, 1987. CDC: National Office of Public Health Genomics, (2007) Retrieved from, www.cdc.gov/genomics/events/file/print/NCI2007-Sept20 pdf.