Transitions in Public Health Boris D. Lushniak, MD, MPH Rear Admiral, USPHS (Ret) Dean and Professor, School of Public Health, University of Maryland 31OCT2017 The events of late 2001 have made bioterrorism a reality on the soil of our nation. As experts in diseases of the skin, dermatologists can better diagnose skin disease, including those caused by biological weapons, than any other physician. Another of our goals is to educate non-dermatologists regarding the skin signs of biological agents used by terrorists. After a short background about biological warfare in general, this talk will focus on anthrax and smallpox with less attention paid to plague, tularemia, and viral hemorrhagic fevers.

Disclaimer The views expressed in this presentation are those of the author and do not reflect the official policy or position of the University of Maryland

Defining Health Health: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO Constitution)

Public Health 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. CEA Winslow, 1920

Core Public Health Functions Assessment and monitoring of the health of communities and populations at risk identify health problems and priorities - surveillance The formulation of public policies designed to solve identified local and national health problems and priorities Assure that all populations have access to appropriate and cost-effective care including health promotion and disease prevention services evaluation of the effectiveness of that care

Public Health Core Functions and 10 Essential Services

Public Health Model Implementation: How do you do it? Intervention Evaluation: What works? Risk Factor Identification: What is the cause? Surveillance: What is the problem? Problem Response

Public health agenda The nature of the hazards to health Our ability to counteract those hazards Prior to WW I Poverty Infectious disease Inadequate delivery of medical care Today, chronic and sociological conditions have been added to infectious diseases

10 Great Public Health Achievements-US 1900-1999 Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of water Recognition of tobacco as a health hazard MMWR 1999 Apr 2;48(12):241-3.

Epidemiologic transitions The Age of Pestilence and Famine: Where mortality is high and fluctuating, precluding sustained population growth, with low and variable life expectancy, vacillating between 20 and 40 years. The Age of Receding Pandemics: Where mortality progressively declines, with the rate of decline accelerating as epidemic peaks decrease in frequency. Average life expectancy increases steadily from about 30 to 50 years. Population growth is sustained and begins to be exponential. The Age of Degenerative and Man-Made Diseases: Mortality continues to decline and eventually approaches stability at a relatively low level.

Health transitions in 20th century Source: http://www.nature.com/nature/journal/v406/n6797/full/406762a0.html

Adapted from Morens DM et al 2004, Nature 430:242-49

University of Maryland School of Public Health