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Public Health in the United States: BACK TO THE FUTURE Jay H. Glasser, Ph.D., president-elect American Public Health Association.

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Presentation on theme: "Public Health in the United States: BACK TO THE FUTURE Jay H. Glasser, Ph.D., president-elect American Public Health Association."— Presentation transcript:

1 Public Health in the United States: BACK TO THE FUTURE Jay H. Glasser, Ph.D., president-elect American Public Health Association

2 The Seaman’s Retreat Hospital being now entirely free from debt, the trustees are enabled to offer the merchant marine the following schedule of reduced fees, viz.:

3 At the Gates - Our Safety Depends on Eternal Vigilance

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5 The Nation's Health Dollar: 2000 Where It Came From

6 Where It Went

7 Probability of Being Uninsured for Population Under Age 65, By State,

8 Levels of Analysis for Examining the Effects of Uninsurance

9 HEALTH and DEVELOPMENT in the 20th CENTURY from The World Health Report 1999, Making a Difference (WHO, Geneva) “The 20th century has seen a global transformation in human heath unmatched in history” “Economic historians and demographers debate the genesis of increases in life expectancy...at least partially linked to the economic changes resulting from the agricultural and industrial revolutions. One aspect the economic change-urbanization-actually affected health adversely by exposing an increasing proportion to crowded conditions, thereby facilitating the spread of infection. Somewhat more counterbalancing this effect though were increases in nutrient intake and improvements in sanitation and water supply resulting from higher income levels”

10 FOUR AIMS of STEPHEN SMITH and THE 7 FOUNDERS OF THE AMERICAN PUBLIC HEALTH ASSOCIATION (April 18,1872) Through the medium of a national organization: 1.awaken and maintain the active and permanent interest of people in sanitary administration 2.greatly facilitate the enlightenment of the the public 3.promote the appointment of more competent health authorities 4.the advancement of sanitary science and promotion of organizations and measures for practical application to public hygiene.” The founders included physicians, a superintendent of health, a military and legal medical specialist, an architect, health statistician, an urban housing specialist

11 CDC’s role as a sentinel for the health of people in the United States and throughout the world. CDC strives to promote disease prevention and health promotion goals that will foster a safe and healthful environment where health is protected, nurtured, and promoted. GOALS SCIENCE Assure a strong science base for public health action ASSESSMENT Detect and assess threats to public health POLICY Provide leadership for the Nation in prevention policy and practice ASSURANCE Assure the public's health through the translation of research into effective community-based action CDC VISION FOR THE 21 ST CENTURY HEALTHY PEOPLE IN A HEALTHY WORLD— THROUGH PREVENTION

12 Tools of Prevention Surveillance Surveillance Health Statistics Health Statistics Epidemiology Epidemiology Laboratory Laboratory Behavioral Risk Reduction Behavioral Risk Reduction Technology Transfer Technology Transfer Prevention Research, Strategies, and Programs Prevention Research, Strategies, and Programs Health Communication and Social Marketing Health Communication and Social Marketing CDC VISION FOR THE 21 ST CENTURY HEALTHY PEOPLE IN A HEALTHY WORLD— THROUGH PREVENTION

13 AND THEN 9/11

14 BIOTERRORISM : Anything is Possible?

15 The Two Book Ends of Terrorism Traditional Terrorism Post Modern Traditional Terrorism Post Modern BIG SMALL BIG SMALL BOOM SILENT BOOM SILENT BAND SINGLE BAND SINGLE BRIEF SUSTAINED BRIEF SUSTAINED

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17 Old Scourges Return in Weaponized Versions?

18 A R E W E UP TO D A T E ?

19 Or do it the old way? Patron Saint of Palermo, Italy Delivered a Miracle: Saved the City from Plague in 1634

20 Conference Report on Public Health Security and Bioterrorism Preparedness and Response Act- HR 3448 Requires Preparedness Plans: respond to bioterrorism and other public health emergencies Preparedness Plans: respond to bioterrorism and other public health emergencies Other Preparedness: children and terrorism, emergency public information and communication, education programs for children and vulnerable people, availability of Potassium Iodide within to populations within 20 miles of a nuclear power plant Other Preparedness: children and terrorism, emergency public information and communication, education programs for children and vulnerable people, availability of Potassium Iodide within to populations within 20 miles of a nuclear power plant

21 Control on Biological Agents and Toxins Registration RequirementRegistration Requirement Protection of Animals and PlantsProtection of Animals and Plants Security and Personnel ScreeningSecurity and Personnel Screening Food Supply Protection: detaining food, bar certain food importers, increase inspections Food Supply Protection: detaining food, bar certain food importers, increase inspections Drug Supply Protection: registration of foreign manufacturers of import drugs and devices Drug Supply Protection: registration of foreign manufacturers of import drugs and devices Water Supply Protection, vulnerability Assessment, emergency response plans, prevent intentional contaminationWater Supply Protection, vulnerability Assessment, emergency response plans, prevent intentional contamination

22 Conference Report on Public Health Security and Bioterrorism Preparedness and Response Act- HR 3448 BIOTERRORISM PREPAREDNESS Emergency Medical Stockpiles$1.15 Billion Emergency Medical Stockpiles$1.15 Billion Center for Disease Control$300 Million Center for Disease Control$300 Million State and Local Preparedness$1.6 Billion State and Local Preparedness$1.6 Billion Hospital and Clinic Preparedness$520 Million Hospital and Clinic Preparedness$520 Million Antimicrobial Resistance$25 Million Antimicrobial Resistance$25 Million Food Supply Protection$100 Million Food Supply Protection$100 Million Water Supply Protection$160 Million Water Supply Protection$160 Million

23 AND BREAKING NEWS from The President

24 Proposed Cabinet-Level Homeland Security Department Would Be Responsible for Dealing with Biological/Chemical Attacks The department would have four main divisions: Chemical, Biological, Radiological and Nuclear CountermeasuresChemical, Biological, Radiological and Nuclear Countermeasures Emergency Preparedness and ResponseEmergency Preparedness and Response Information Analysis and Infrastructure ProtectionInformation Analysis and Infrastructure Protection Border and Transportation SecurityBorder and Transportation Security Source: Ricks, Washington Post, June 7, 2002

25 Public Health Responsibilities Source: various newspapers June 7, 2002 In the new department, a division would be tasked with protecting against chemical, biological and nuclear threats, assuming control of public health, defense and research operations currently handled by the Departments of Health and Human Services, Energy and Agriculture The CDC's Bioterrorism Preparedness and Response Program, which distributes funds to the states, and National Pharmaceutical Stockpile Program likely would be shifted to the new department, Those two programs means that the CDC would lose about 300 employees and $4 billion from its budget The emergency response division would be responsible for responding to an attack involving weapons of mass destruction, absorbing responsibilities held by HHS' Chemical, Biological, Radiological and Nuclear Response Assets operation.

26 Public Health Responsibilities Source: various newspapers June 7, 2002 The new department's border and transportation division would absorb the Agriculture Department's Animal and Plant Health Inspection ServiceThe new department's border and transportation division would absorb the Agriculture Department's Animal and Plant Health Inspection Service In a televised speech to outline his plan, Bush said the new department would "bring together our best scientists to develop technologies that detect biological, chemical and nuclear weapons." He added that it would "discover the drugs and treatments to best protect our citizens"In a televised speech to outline his plan, Bush said the new department would "bring together our best scientists to develop technologies that detect biological, chemical and nuclear weapons." He added that it would "discover the drugs and treatments to best protect our citizens" Bush hopes to have the new department running by Jan. 1, It remains uncertain if Bush will nominate Ridge to head the new department (Wall Street Journal, 6/7).Bush hopes to have the new department running by Jan. 1, It remains uncertain if Bush will nominate Ridge to head the new department (Wall Street Journal, 6/7).

27 And from Congress: First Amendment to HR 4775 Sen Dirksen, “Well you know what they say about the Federal Budget, a billion here and a billion there and before long it starts to add up to real money.” 31 bil. total 14 bil military operations 8.3 bil homeland security 5.5 N bil NYC Sept 11th recovery includes mass transit 1.35 bil foreign aid Afghanistan, Pakistan, Russia, 200 mil AIDS program to focus on mother to child transmission 100 mil for AIDS Global Fund 4.4 bil Transportation Security Administration (includes airport security)

28 and 417 mil Veterans Adm Medical care First Responders 1 bil Port Security 970 mil Nuclear Laboratory 200 mil Cyber security 115 mil Agroterrorism 200 mil Water systems reviews Secret Service and FBI, national monument 340 mil US Postal Service effort 87 mil Nuclear non proliferation 100 mil And from Congress: First Amendment to HR 4775 (continued)

29 Is there a new Spirit of Patriotism and Service? Where will it Lead?

30 BACK TO THE FUTURE?

31 THE PUBLIC HEALTH MISSION of HEALTHY PEOPLE in HEALTHY COMMUNITIES ( July 1995 consensus statement of Public Health Steering Committee ) PREVENTS EPIDEMICS and the spread of disease PREVENTS EPIDEMICS and the spread of disease PROTECTS against ENVIRONMENTAL HAZARDS PROTECTS against ENVIRONMENTAL HAZARDS PREVENTS INJURIES PREVENTS INJURIES PROMOTES and encourages HEALTHY BEHAVIORS PROMOTES and encourages HEALTHY BEHAVIORS RESPONDS to DISASTERS and assists communities in recovery RESPONDS to DISASTERS and assists communities in recovery ASSURES the QUALITY and ACCESSABILITY of HEALTH SERVICES ASSURES the QUALITY and ACCESSABILITY of HEALTH SERVICES

32 CONTEMPORARY PROBLEMS

33 In 1964, Smoking And Health Captured the Permanent Attention of Physicians and The Nation

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36 As We Face the Known and Unknown

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38 LEADERSHIPLEADERSHIP

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42 APHA INITIATIVES and ALLIANCES ELIMINATING ETHNIC and RACIAL HEALTH DISPARITIESELIMINATING ETHNIC and RACIAL HEALTH DISPARITIES EMS and PUBLIC HEALTH COALITION FOR HOMELAND SECURITYEMS and PUBLIC HEALTH COALITION FOR HOMELAND SECURITY MEDICINE and PUBLIC HEALTH INITITATIVE (AMA, APHA and partners)MEDICINE and PUBLIC HEALTH INITITATIVE (AMA, APHA and partners) THE PUBLIC HEALTH WORKFORCE & STANDARDSTHE PUBLIC HEALTH WORKFORCE & STANDARDS Continuing Education and Credentialing Standards for Public Health Entities HUMAN RIGHTS and HEALTH CURRICULUMHUMAN RIGHTS and HEALTH CURRICULUM GLOBAL HEALTH: The World Federation of Public Health AssociationsGLOBAL HEALTH: The World Federation of Public Health Associations

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45 Estimated 42.1 Million Uninsured People

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49 TEN ESSENTIAL PUBLIC HEALTH SERVICES MONITOR HEALTH STATUS and identify community problems MONITOR HEALTH STATUS and identify community problems DIAGNOSE and INVESTIGATE HEALTH PROBLEMS and health hazards in the community DIAGNOSE and INVESTIGATE HEALTH PROBLEMS and health hazards in the community INFORM, EDUCATE and EMPOWER PEOPLE about Health Issues INFORM, EDUCATE and EMPOWER PEOPLE about Health Issues MOBILIZE COMMUNITY PARTNERSHIPS to identify and solve community health efforts MOBILIZE COMMUNITY PARTNERSHIPS to identify and solve community health efforts

50 ENFORCE LAWS and Regulates that PROTECT HEALTH and Ensure Safety ENFORCE LAWS and Regulates that PROTECT HEALTH and Ensure Safety LINK PEOPLE to NEEDED PERSONAL HEALTH SERVICES and Assure the Provision of Health Care When Otherwise Available LINK PEOPLE to NEEDED PERSONAL HEALTH SERVICES and Assure the Provision of Health Care When Otherwise Available ASSURE a COMPETENT PUBLIC HEALTH and Personal Health Care WORKFORCE ASSURE a COMPETENT PUBLIC HEALTH and Personal Health Care WORKFORCE EVALUATE EFFECTIVENESS, ACCESSIBILITY and QUALITY of personal and population -based HEALTH SERVICES EVALUATE EFFECTIVENESS, ACCESSIBILITY and QUALITY of personal and population -based HEALTH SERVICES RESEARCH for NEW INSIGHTS and INNOVATIVE SOLUTIONS to Health Problems RESEARCH for NEW INSIGHTS and INNOVATIVE SOLUTIONS to Health Problems

51 THE APHA and AMA Medicine and Public Health Initiative

52 Federal-Aid Highway Act of 1956: CREATING THE INTERSTATE SYSTEM Eisenhower planned to address a conference of state governors in Lake George, N.Y., July 12, The president was unable to attend, and Vice President Richard M. Nixon delivered the message. Nixon told the governors that the increased funding authorized earlier that year was "a good start" but "a $50 billion highway program in 10 years is a goal toward which we can - and we should - look." Such a program, over and above the regular federal- aid program, was needed because "... our highway network is inadequate locally, and obsolete as a national system

53 Federal-Aid Highway Act of 1956: CREATING THE INTERSTATE SYSTEM Eisenhower’s first realization of the value of good highways occurred in 1919, when he participated in the U.S. Army's first transcontinental motor convoy from Washington, D.C., to San Francisco. The convoy experienced all the woes known to motorists - an endless series of mechanical difficulties; vehicles stuck in mud or sand; trucks and other equipment crashing through wooden bridges; and, for the soldiers, worst of all, speeches in every town along the way. After 63 days on the road, the convoy reached San Francisco, where it was greeted with medals, a parade, and more speeches

54 Together, the united forces of our communication and transportation systems are dynamic elements in the very name we bear - United States. Without them, we would be a mere alliance of many separate parts." - President Dwight D. Eisenhower, Feb. 22, 1955President Dwight D. Eisenhower

55 WHAT KIND OF TENT? INTENT of Public Health and CONTENT of Public Health Public Health is an admixture, a complex evolution that parallels society in all respects, advancement and enduring problems, and not without critics Looking Back, The Three Eras of Public Health Sanitation Biological Behavioral Sanitation Biological Behavioral Looking Forward, Genetics, nanobiology, informatics, health care/self care advancement and complexity, implosion......? Critics such as Dr. Sally Satel now say there is fourth revolution: politically correct medicine “powered by the idea that injustice produces disease and political empowerment is the cure” Critics such as Dr. Sally Satel now say there is fourth revolution: politically correct medicine “powered by the idea that injustice produces disease and political empowerment is the cure” source: PC MD: How Political Correctness is Corrupting Medicine, Basic Books, 2000 “If you reach a fork in the road...take it” Yogi Berra “If you reach a fork in the road...take it” Yogi Berra

56 Stephen Smith, 1921, at age 98, addressing APHA members on the 50th Anniversary of APHA “So let us on this most auspicious anniversary look backward and learn the lessons of experience which it teaches before we take a step into the uncharted future.”

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