Public Health Overview Sam Stebbins, MD, MPH San Mateo County Public Health...
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Public Health OverviewPublic Health Overview
Sam Stebbins, MD, MPHSam Stebbins, MD, MPH
San Mateo County Public HealthSan Mateo County Public Health
[email protected]@co.sanmateo.ca.us
What is Public Health?What is Public Health?The science and art of preventing disease, The science and art of preventing disease, prolonging life, and promoting health through prolonging life, and promoting health through organized efforts of society. organized efforts of society.
Public health is the organised response by Public health is the organised response by society to protect and promote health and to society to protect and promote health and to prevent illness, injury and disabilityprevent illness, injury and disability
Public health is community health. It has Public health is community health. It has been said that: "Health care is vital to all of us been said that: "Health care is vital to all of us some of the time, but public health is vital to some of the time, but public health is vital to all of us all of the time.”all of us all of the time.”
What is Public Health?What is Public Health?
……what society does collectively to what society does collectively to assure the conditions for people to be assure the conditions for people to be healthy.healthy.
Health Department
Hospitals MCO Group
Practices
MCO MDs
Nursing FacilitiesMDs
Mental Health
Voluntary Agencies
Social Services
Churches
Group Practices
Nursing Facilities
MCOs
Home Health
Employers
Drug Treatment
Schools
Local Public Health System
MCO Hospitals
Public Health is the ultimate Public Health is the ultimate systems challengesystems challenge
The “Web” of CausalityThe “Web” of Causality
What is the cause?What is the cause? Necessary factorsNecessary factors Augmenting Augmenting
factorsfactors
10 greatest public health 10 greatest public health achievements of the 20achievements of the 20thth century century
VaccinationVaccination Motor Vehicle Motor Vehicle
SafetySafety Safer WorkplacesSafer Workplaces Control of Control of
Infectious DiseasesInfectious Diseases Decreased deaths Decreased deaths
from heart disease from heart disease and strokeand stroke
Safer FoodsSafer Foods Healthier Mothers Healthier Mothers
and Babiesand Babies Family PlanningFamily Planning Fluoridation of Fluoridation of
Drinking WaterDrinking Water Tobacco ReductionTobacco Reduction
MASS PROPHYLAXIS
The ability to provide antibiotics, vaccination and/or medical triage to all residents of San Mateo County in an emergency as quickly and effectively as possible
The 3 Kinds of PreventionThe 3 Kinds of Prevention
Primary PreventionPrimary Prevention
Secondary PreventionSecondary Prevention
Tertiary PreventionTertiary Prevention
What is “pre-diabetes”?What is “pre-diabetes”?
Impaired Glucose Impaired Glucose ToleranceTolerance Impaired fasting Impaired fasting
glucoseglucose 110-125 mg/dL110-125 mg/dL Greater than “normal” Greater than “normal”
but less than but less than >> 126 126 which is diagnostic of which is diagnostic of diabetesdiabetes
I. Role of the Public Health I. Role of the Public Health LaboratoryLaboratory
1. To provide laboratory tests for the 1. To provide laboratory tests for the various program units of the health various program units of the health departmentdepartment
2. To assist in the diagnosis, control, and 2. To assist in the diagnosis, control, and prevention of communicable diseases and prevention of communicable diseases and other illnesses of public health concernother illnesses of public health concern
3. To provide specialized knowledge in 3. To provide specialized knowledge in public health microbiology for the purpose public health microbiology for the purpose of consultation with other specialists in the of consultation with other specialists in the countycounty
II. Practices of P.H. LaboratoryII. Practices of P.H. Laboratory
A. To provide laboratory services A. To provide laboratory services 1. STD control1. STD control 2. TB control2. TB control 3. CD control3. CD control 4. Environmental Health4. Environmental Health 5. Zoonotic disease control5. Zoonotic disease control 6. Epidemiological investigations6. Epidemiological investigations 7. Educational activities7. Educational activities
Nuestro Canto de SaludNuestro Canto de Salud-Our Song of Health-Our Song of Health – –
PartnersPartners
Goals & ObjectivesGoals & Objectives
StrategiesStrategies
Community FocusedCommunity Focused
Bridging medical expertise and community outreach to Bridging medical expertise and community outreach to implement culturally/linguistically appropriate health care implement culturally/linguistically appropriate health care
services.services.
Chronic Disease Management Chronic Disease Management TeamTeam
Health Promoters (Promotores de Salud)Health Promoters (Promotores de Salud)
Community & Street OutreachCommunity & Street Outreach
Community Presentations/EventsCommunity Presentations/Events
Resource referralsResource referrals
Community screeningsCommunity screenings
Community Health WorkersCommunity Health Workers
Clinical Team (RN/RD/CDE)Clinical Team (RN/RD/CDE)
StrategiesStrategies
Demystify health through training & field Demystify health through training & field experienceexperience
Utilize natural support networks & Utilize natural support networks & environmentsenvironments
Community access to prevention & Community access to prevention & interventionintervention
Link to needed medical careLink to needed medical care
DefinitionDefinition
Epidemiology is Epidemiology is TheThe study study of the of the distributiondistribution and and
determinants determinants of health related states or of health related states or events in specified populations, and events in specified populations, and
TheThe application application of this study to the of this study to the control of health problemscontrol of health problems
Objectives of EpidemiologyObjectives of Epidemiology Identify cause of a disease and risk factorsIdentify cause of a disease and risk factors Determine extent of disease found in a Determine extent of disease found in a
communitycommunity Study the natural history and prognosis of Study the natural history and prognosis of
diseasedisease Evaluate existing and new preventive and Evaluate existing and new preventive and
therapeutic measurestherapeutic measures Provide foundation for developing public Provide foundation for developing public
policy and regulatory decisionspolicy and regulatory decisions
Distribution: Distribution: Descriptive Epidemiology Descriptive Epidemiology
The frequency and pattern of health The frequency and pattern of health events in a populationevents in a population
The The who, what, where, whenwho, what, where, when, ,
and and how manyhow many
Determinants:Determinants: Analytic Epidemiology Analytic Epidemiology
The The how how and and whywhy Do schools with snack and soda machines Do schools with snack and soda machines
have higher rates of obesity than schools have higher rates of obesity than schools without?without?
Do smokers have higher rates of lung Do smokers have higher rates of lung cancer than nonsmokers?cancer than nonsmokers?
PrevalencePrevalence
Proportion of persons in a population Proportion of persons in a population that has diseasethat has disease
Number of persons with condition at a given timeNumber of persons with condition at a given time
Number of persons in the population at that timeNumber of persons in the population at that time
Prevalence of Obesity Prevalence of Obesity among among
U.S. Adults, BRFSS, 1993U.S. Adults, BRFSS, 1993
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.
<10%<10% 10-15% 10-15% >15%>15% N/A N/A
Prevalence of Obesity Prevalence of Obesity among among
U.S. Adults, BRFSS, 1996U.S. Adults, BRFSS, 1996
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.
<10%<10% 10-15% 10-15% >15%>15% N/A N/A
Prevalence of Obesity Prevalence of Obesity among among
U.S. Adults, BRFSS, 1999U.S. Adults, BRFSS, 1999
Source: Mokdad A H, et al. Am Med Assoc 2000;284:13
<10%<10% 10-15% 10-15% >15%>15% N/A N/A
IncidenceIncidence
Proportion of a population at risk that Proportion of a population at risk that becomes diseased over a specified becomes diseased over a specified period of timeperiod of time
Number of new events during a given timeNumber of new events during a given time____________________________
Number of people at risk during a given timeNumber of people at risk during a given time
Test CharacteristicsTest Characteristics
Is the test useful? Is the test useful? Will it accurately identify who really does Will it accurately identify who really does
and does not have the condition?and does not have the condition?
Testing: SensitivityTesting: Sensitivity
The proportion of people with disease The proportion of people with disease who are correctly identified as such by who are correctly identified as such by the testthe test
The probability of a positive test if The probability of a positive test if disease is presentdisease is present Is the test sensitive enough to find Is the test sensitive enough to find
everyone with the condition?everyone with the condition?
Testing: SpecificityTesting: Specificity
The proportion of people without The proportion of people without disease who are correctly identified as disease who are correctly identified as such such
The probability of a negative test if The probability of a negative test if disease is absentdisease is absent Is a positive test result specific to this Is a positive test result specific to this
disease, identifying only people who truly disease, identifying only people who truly have it?have it?
Modes of transmissionModes of transmission
DirectDirect Direct contact (kissing, skin-to-skin, Direct contact (kissing, skin-to-skin,
sexual intercourse)sexual intercourse) Droplet spread Droplet spread Vertical transmissionVertical transmission
Modes of transmissionModes of transmission
IndirectIndirect Airborne (dust, droplet nuclei)Airborne (dust, droplet nuclei) Vehicle-borne (food, water, soil, bio Vehicle-borne (food, water, soil, bio
product, fomites)product, fomites) Vector-borne (mechanical, biological)Vector-borne (mechanical, biological)
What is an outbreak?What is an outbreak?
Outbreak (AKA epidemic) – the occurrence Outbreak (AKA epidemic) – the occurrence of cases of an illness clearly in excess of of cases of an illness clearly in excess of expectancy for a given time periodexpectancy for a given time period
Endemic – persistent or baseline level of Endemic – persistent or baseline level of disease; the level of disease usually present disease; the level of disease usually present in a community (not necessarily the in a community (not necessarily the preferred level)preferred level)
Pandemic – when an epidemic spreads over Pandemic – when an epidemic spreads over several countries or continent (the Spanish several countries or continent (the Spanish flu pandemic of 1918)flu pandemic of 1918)
Why Investigate an Outbreak?Why Investigate an Outbreak?
To identify additional unreported or To identify additional unreported or unrecognized casesunrecognized cases
To control the spread of diseaseTo control the spread of disease To identify the source or vehicle of infection To identify the source or vehicle of infection
(to control or eliminate it)(to control or eliminate it) To learn more about the disease itself To learn more about the disease itself
(natural history of disease, clinical (natural history of disease, clinical spectrum, descriptive epidemiology, and spectrum, descriptive epidemiology, and risk factors)risk factors)
Disease Reporting in San Mateo County:Disease Reporting in San Mateo County: Call (650) 573-2346 (regular hours)Call (650) 573-2346 (regular hours) Call (650) 363- 4981 (after hours – urgent needs)Call (650) 363- 4981 (after hours – urgent needs) Fax (650) 573 - 2919Fax (650) 573 - 2919
San Mateo County: www.smhealth.orgSan Mateo County: www.smhealth.org What diseases to report and how to report themWhat diseases to report and how to report them Restaurant inspection resultsRestaurant inspection results Beach and stream water quality testingBeach and stream water quality testing How to dispose of household hazardous wastesHow to dispose of household hazardous wastes Local/State bioterrorism and disaster resourcesLocal/State bioterrorism and disaster resources
Local Data: www.plsinfo.org/healthysmc/Local Data: www.plsinfo.org/healthysmc/ Immunizations: http://www.immunize.org/Immunizations: http://www.immunize.org/ American Public Health Assoc: www.apha.orgAmerican Public Health Assoc: www.apha.org
Really Useful Information