Overview of Public Health—Part 2 (1)

8/13/2019 Overview of Public HealthPart 2 (1)

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Overview of Public Health

(Part 2)

Richard Taylor, PhD, MPH


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Learning Objectives

Define eras of public health

Illustrate the uses of health care, traditionalpublic health, and social interventions inpopulation health

Identify a range of determinants of disease Describe major public health achievements in

20thCentury

Discuss modern public health challenges


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History of Public Health


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Mohenjo-Daro and Harappa

Civilizations
http://en.wikipedia.org/wiki/File:Civilt%C3%A0ValleIndoMappa.png


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Well and bathing platforms

Harappa


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Palace of Knossos on Crete

~2,000 B.C.

Magnificent bathing

facilities

Flushingarrangements for

toilets


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Era of Health Protection

Antiquity1830s

Focus; Authority-based control of

individual and community behaviors

Framework: Religious and cultural

practices and prohibited behaviors

Examples: Isolation and quarantine

Sexual prohibitions

Dietary restrictions


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James Lind

1740s British Naval

commander

Demonstrated lemons and

other citrus fruitcould prevent and

treat scurvy

One of the first clinical

experiments recorded


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Edward Jenner (17491823)

Last years of 18thcentury

English physician

Father of immunology Cowpox protected

those who developed itagainst smallpox

Innoculated JamesPhipps in 1796

1979 Smallpoxeradicated


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Hygiene movement

18401870s

Focus: improve health through improved

sanitary conditions

Framework: Community-based

environmental improvements

Examples: John Snow on Cholera

Semmelweiss and puerperal fever


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Ignaz Semmelweis (18181865)

1847 incidence ofpuerperal fever(childbed fever) couldbe controlled by handwashing.

Could reducematernal mortalityfrom 10%35% toless than 1%.


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Vital Statistics

Mid-19thcentury in

England

Development of birth

and death records Allowed for

population-wide

assessment of health

status

Edwin Chadwick

William Farr


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Contagion Control

18801940s

Focus: Germ theory,

infectious origins of

disease Framework: Control of

communicable disease,

vaccination, sanatoriums,

Examples:

Tb Sanatoriums,

Outbreak investigations

Louis Pasteur


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Sanitation and Hygiene

Population shift led to repeated disease

outbreaks

1900,

40 of 45 states had established health departments

Collective public health action

19301950

Improvements in sewage disposal

Water treatment

Food safety

Organized solid waste removal


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Sir Alexander Fleming (18811955)

Scientist who

discovered penicillin

First used in March

1942 to treatstreptococcal

infection


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Post WWII: Advancing the

Medical Care System 1950smid 1980s

Focus: Control of communicable disease

Risk factor modification

Target of high-risk populations

Framework: public system for care of and specific control of diseases and

vulnerable populations

Integration of preventive services

Examples: Antibiotics

1965 establishment of Medicare and Medicaid

Clinical trials; community trials

Health maintenance organizations


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Health Promotion and Disease

Prevention Mid-1980s2000

Focus:

Individual behavior

Disease detection

Framework

Population prevention

Clinical prevention

Multiple interventions

Examples

Early Screening for

cancer


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Population Health

21stCentury Approach

Focus:

Coordinated public health and health

care delivery based on shared

evidence-based systems thinking

Frameworks

Globalization

Cost vs. benefit analysis

Community and population level

interventions thinking

Examples

Health informatics

Antibiotic resistance

Global collaboration


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Risk: Everyone vs.

Vulnerable Groups High-risk approach

Focus on only those

with highest risk to

bring them toward the

average

Smokers

Occupational groups

High-risk sexual

behaviors

Improving the

average approach

Everyone has some

degree of risk. Reduced cholesterol

levels through diet

Presidential Challenge

Weight loss programs

to reduce risk ofdiabetes.

Age Adj sted Death Rates* for the 10 Leading


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Age-Adjusted Death Rates* for the 10 Leading

Causes of DeathNational Vital Statistics System,

United States, 2006 and 2007

*Rate per 100,000 U.S. standard population.Data for 2006 are final. Data for 2007 are preliminary.


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Deaths and Death RatesTexas 19432007


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On an Average Day In Texas

2007 The Population Increased by

678 Persons. [The rate ofnatural increase (Births -Deaths)]

There were 1,116 ResidentBirths

53 babies had no prenatalcare

94 low birth weight babieswere born (less than 2,500grams or less than 5 lbs. 9oz.)

54 babies were born toteenage mothers (less than 18years of age)

376 babies were delivered byC-section

There were 439 ResidentDeaths 108 of these deaths were due

to heart disease

96 of these deaths were dueto cancer

26 of these deaths were dueto accidents

7 of these were infant deaths

There were 483 Marriages

There were213 Divorces


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Ten Great Public Health Achievements

United States, 19001999

Vaccination

Motor-vehicle safety

Safer workplaces

Control of infectious diseases

Decline in deaths fromcoronary heart disease andstroke

Safer and healthier foods

Healthier mothers and babies

Family planning

Fluoridation of drinking water

Recognition of tobacco use asa health hazard


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Infant mortality rate,* by year



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Maternal mortality rate, by year



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Motor Vehicle Safety


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Motor Vehicle Safety


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Recognition of tobacco use as a

health hazard


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Control of infectious diseases


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Age-adjusted death rates for total cardiovascular

disease, diseases of the heart, coronary heart disease,

and stroke, by yearUnited States, 19001996


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Public Health Challenges

Travel to tropical rain forestsand wilderness habitatsincrease encounters withreservoirs for unknowninfectious diseases

Development of antimicrobialagents has hastened thedevelopment of drugresistance.

Modern medical treatmentsmay lead to increased

acquisition of opportunisticinfections


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Public Health Challenges

Spread of disease through modern

ventilation systems

Spread of disease through blood

transfusions

Food-borne diseases are spread oncentrally processed foods

Airplanes have replaced ships as major

vehicles of international disease spread


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Questions and Discussion


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Recognition of tobacco use as a

health hazard


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Other Public Health Victories

Cumulative gains in public healthat the turn of this century

900,000 fewer reported cases

of measles than 1941

200,000 fewer cases of

diphtheria than 1921

250,000 fewer cases of

whooping cough than 1934

21,000 fewer cases of polio

than in 1951


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Other Public Health Victories

45 Million fewer smokers than expected trends in tobacco use

through 1965

2 Million Americans were alive that would have otherwise have

died from heart disease

Protection of the US Blood supply prevented:

>50,000 HIV infections

1.5 Million Hepatitis B and C infections

Saved more than 3.5 billion in medical costs associated with those

three diseases.

Blood Lead Levels dropped by 1/3 since 1976


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Age-Adjusted Rates* of Death from Heart Disease,

by Race and Sex United States, 19792006

* Per 100,000 standard population. Data for 2006 are preliminary.


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Access to Family Planning


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FIVE LEADING CAUSES OF

DEATH, USA, AGES 1524, 1998

CAUSE PERCENTNUMBER

S

(1) Accidents 51.8% 12,752

(2) Homicide 21.3% 5,233

(3) Suicide 16.3% 4,003

(4) Cancer 6.8% 1,670

(5) Heart Disease 3.9% 961

Five-year averages of annual number of deaths


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Five year averages of annual number of deaths

related to coal mine explosionsUnited states,

19011995

Overview of Public Health—Part 2 (1)

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