Introduction to Healthcare and Public Health in the US

Introduction and History of Modern Healthcare in the US

Lecture bThis material (Comp1_Unit1b) was developed by Oregon Health and Science University, funded by the Department of Health

and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Introduction and History of Modern Healthcare in the USLearning Objectives

2

• Delineate key definitions in the healthcare domain (Lectures a, b, c, d)

• Explore components of healthcare delivery and healthcare systems (Lecture a)

• Define public health and review examples of improvements in public health (Lecture b)

• Discuss core values and paradigm shifts in US healthcare (Lecture c)

• Describe in overview terms, the technology used in the delivery and administration of healthcare (Lecture d)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

Public Health

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

“is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.“

(Winslow, C.E.A. 1920)

10 Great Public Health Achievements – US, 1900-1999

• Vaccination• Motor-vehicle safety• Safe workplaces• Control of infectious diseases• Decline in deaths from coronary heart disease and stroke• Safer and healthier foods• Healthier mothers and babies• Family planning• Fluoridation of drinking water• Recognition of tobacco use as a health hazard

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

Public Health Successes (continued)

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

• Control of infectious diseases– Example: Typhoid

• spread by ingesting contaminated food or water

• In 1891 the typhoid death rate in Chicago alone was 174 per 100,000 people

• Now only about 400 cases are seen in the US each year, most of whom originate when patients travel in developing countries

Public Health Successes (continued)

• Control of infectious diseases– Example: Smallpox

• Epidemic viral illness• In the early 1950s there were about 50

million cases of smallpox each year worldwide

• By 1977, smallpox was eradicated, thanks to an aggressive public health program and the use of an effective vaccine

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

Public Health Successes (continued)

• Control of nutritional deficiencies– Example: Goiter

• Lack of iodine in diet leads to impaired thyroid hormone synthesis and an enlargement of the thyroid gland in the neck (a goiter)

• Fortification of salt with iodine virtually eradicated nutritional goiter in the US

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

Public Health Successes (continued)

• Control of nutritional deficiencies– Example: Tooth Decay

• Adding fluoride to drinking water substantially reduces the incidence of dental caries (tooth decay) in populations

• In 1945 fluoride was added to water in Grand Rapids, Michigan

• Now over 10,000 US communities fluoridate their water

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

How Has Public Health Improved Healthcare?

• Improvements in understanding disease– Epidemiology is considered the basic science

of public health and is• a quantitative basic science• a method of causal reasoning based on developing

and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality

• a tool for public health action to promote and protect the public’s health

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

How Has Public Health Improved Healthcare? (continued)

• An example of epidemiology at work: • In 1854: epidemic of cholera in London,

England• Cholera is a bacterial disease• Lack of sanitation and overcrowding led to

the spread of disease• Dr. John Snow linked the spread of disease

to a contaminated public water pump• Snow’s hypothesis: cholera was spread by

contaminated water10Health IT Workforce Curriculum

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

How Has Public Health Improved Healthcare? (continued)

• Improvements in data collection – Original methods of data collection were

crude– progressive improvement in methodology led

to the use of sophisticated scientific methods to collect data• cohort studies • randomized controlled trials

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Modern Healthcare in the US Lecture b

How Has Public Health Improved Healthcare? (continued)

• Improvements in data collection • Example: the Framingham Heart Study• The study followed patients for a number of

years to identify factors that contribute to the development of cardiovascular disease (CVD)

• Over the years, multiple generations of participants have helped identify major CVD risk factors

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

How Has Public Health Improved Healthcare? (continued)

• Improvements in data analysis (use of tools such as multivariate analysis and meta-analysis)

• Improvement in disease surveillance – Example: the Real-Time Outbreak and

Disease Surveillance (RODS) Laboratory at the University of Pittsburgh, Department of Biomedical Informatics

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Modern Healthcare in the US Lecture b

How has public health improved healthcare? (continued)

• Improvement in training – Establishment of many schools of public health

in the early 20th century– Professional degrees such as Master of Public

Health (M.P.H.)• Improvements in infrastructure

– Federal– State– Local health departments

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Modern Healthcare in the US Lecture b

Introduction and History of Modern Healthcare in the USSummary – Lecture b

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• Public Health Definition• Public Health Successes include the control of:

– Infectious diseases– Nutritional deficiencies– Understanding disease

• Public Health has improved:– Data collection, training and infrastructure

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b

Introduction and History of Modern Healthcare in the US

References – Lecture bReferences• Centers for Disease Control and Prevention - Ten great public health achievements—United States, 1900–1999.

(1999, April 2). MMWR, 48(12), 241-243. • Definition of Epidemiology from Principles of Epidemiology, 2nd edition, CDC Self Study Course 3030-G . (2008).

Retrieved December 6, 2011, from Centers for Disease Control and Prevention website: http://www2a.cdc.gov/phtn/catalog/pdf-file/Epi_course.pdf.

• Ripa, L. W. (1993). A Half-century of Community Water Fluoridation in the United States: Review and Commentary. Dept. of Children’s Dentistry; SUNY Stony Brook, 53(1), Retrieved from http://aaphd.org/docs/position%20papers/A%20Half-Century%20of%20Community%20Water1993.pdf.

• Smallpox. (2001). Retrieved December 6, 2011, from World Health Organization - Media Center website: http://www.who.int/mediacentre/factsheets/smallpox/en/.

• Typhoid Fever in the United States - NH Backgrounder. (2001, April 25). Retrieved December 6, 2011, from National Institutes of Health, National Institute of Child Health and Human Development website: http://www.nichd.nih.gov/news/releases/typhoid_background.cfm.

• Typhoid Fever, Frequently Asked Questions. (2005, January 10). Retrieved December 6, 2011, from Centers for Disease Control and Prevention - National Center for Emerging and Zoonotic Infectious Diseases website: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/.

• Vandenbroucke, J. P. (1998). Clinical investigation in the 20th century: the ascendency of numerical reasoning. Lancet, 352 (suppl 2)(12), 6. Retrieved from http://www.rods.pitt.edu/site.

• William B. Kannel, MD - Pioneer in Cardiovascular Epidemiology, 1923–2011 . (2011, January 10). Retrieved December 6, 2011, from Framingham Heart Study website: http://www.framinghamheartstudy.org/index.html.

• Winslow, C. E. (1920). The Untilled Fields of Public Health. Science, n.s. 51, 23.

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Introduction to Healthcare and Public Health in the US Introduction and History of

Modern Healthcare in the US Lecture b