What is Public Health all about? Public health. Many people mistakenly assume public health services are just for some people, perhaps those without health insurance or those with special health issues. But in reality, public health is for all of us. Like the public library, public schools, public utilities. . . public health has the mission of protecting and improving the health and well-being of all people. Lecture 12

What does Public Health do? Provide disease control and prevention Assure air and water quality Promote healthy lifestyles So what does our public health system do? Our public health efforts focus on broad health issues such as preventing and controlling disease… keeping our environment clean, healthy, and safe… and promoting good health practices.

Public Health is a wise investment It helps people: Save money Enjoy good health Live longer Our public health system really pays off. The investment in prevention and education returns marked savings in health care costs. Plus people feel better and live longer.

Public Health Achievements in the 20th Century Let's take a closer look at how public health initiatives have improved our lives. . . . in many, many ways. In this next series of slides we will take a brief look at the Ten Great Public Health Achievements in the 20th Century as defined by the Center for Disease Control, USA

Immunizations have virtually eliminated: Smallpox ( either by Variola major and Variola minor) Diphtheria (Corynebacterium diphtheriae) Pertussis (whooping cough/  Bordetella pertussis) Tetanus (Clostridium tetani) Polio Measles (rubeola/ paramyxovirus genus Morbillivirus) Rubella ( German measles/ rubella virus) Since 1900, 22 vaccines have been developed which are effective against debilitating diseases. Half of these vaccines have been recommended for use in all U.S. children. The others are recommended only for high-risk populations. Because of public health efforts supporting nationwide immunization programs, diseases which once killed hundreds of thousands of people each year are now rare.

Safe and healthier foods are now commonplace because of: Hand washing Sanitation Refrigeration Pasteurization Pest control Healthier animal care, feeding, and processing Improved food supply safety Food safety education, handling practices, and laws have substantially decreased problems from contamination. Plus, the establishment of food fortification programs has almost eliminated major nutritional deficiency diseases such as rickets, goiter and pellagra in the U.S. All these advances are a result of public health efforts.

Fluoridation Primary factor in the decline of tooth decay Benefits all, regardless of age, education, or income Fluoridation of community drinking water is the major factor responsible for the substantial decline in tooth decay during the second half of the 20th century, again thanks to public health policy development efforts. Although other fluoride-containing products are available, water fluoridation remains the most equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level.

Coronary heart disease and stroke The leading cause of death in the U.S. despite a 60% decrease in death rates since 1950. Public health advances in addressing coronary heart disease are a truly good news, bad news story. Heart disease has been the leading cause of death in the United States since 1921, and stroke has been the third leading cause since 1938. Together they still account for approximately 40% of all deaths today. Since 1950, age-adjusted death rates from cardiovascular disease have declined 60%, representing one of the most important public health achievements of the 20th century. Despite the remarkable progress, heart disease and stroke remain leading causes of disability and death in our country.

Recognition of tobacco as a health hazard Smoking, once socially acceptable, is on the decline among U.S. adults. % of population who smoke 1965–42.4% 1997–24.7% Reductions in smoking have resulted from many factors promoted through national public health network. Education on the effects of tobacco use, prevention and cessation programs, campaigns by advocates for nonsmokers' rights, restrictions on cigarette advertising, legislation restricting smoking in public places, and increased taxation have all lead to lower smoking rates among U.S. adults.

Motor vehicle safety 1925–18 deaths per million VMT While still the nation's leading cause of death due to injury, motor vehicle mortality rates have decreased dramatically since the early days of the automobile. Even with a 10-fold increase in motor vehicle travel, deaths per vehicle mile traveled decreased 90% from 1925 to 1997. VMT: vehicle miles traveled

Motor vehicle safety Public Health efforts have influenced: Increased seat belt use Vehicle safety improvements Traffic safety regulation and enforcement Improved streets and highways The decrease in motor vehicle deaths can be attributed primarily to the public health focus on improvements in vehicle safety features, public education on the importance of safety belts, enforcement of traffic laws, and improved streets and highways.

Mother and infant mortality rates Maternal mortality rates down 99% Infant mortality rates down 90% Since the turn of the century, maternal mortality rates have decreased almost 99%, and infant mortality more than 90%. In 1997, 28,045 infants died before age one. Had the death rate stayed at the early 1900 levels, 500,000 infants would have died in 1997.

Mother and infant mortality rates Improved standards of living Technological advances in medicine Greater access to maternal and well-baby care Family planning Desired birth spacing and family size The decrease in mortality rates of both mother and child has many factors including public health intervention in areas such as nutrition, education, environmental regulation, disease prevention, and medical care. The hallmark of family planning in the United States has been the ability to achieve desired birth spacing and family size. Smaller families and longer birth intervals have contributed to the better health of infants, children, and women, and have improved the social and economic role of women.

Safer, healthier workplaces e.g. Mining safety Industrial safety Indoor air quality Ergonomics Assuring a safer, healthier workplace has long been a key public health objective. Much has been done to provide workers a productive and safe working life, and a retirement free from long-term consequences of occupational disease and injury. Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of the working population. Effective and successful "fits" assure high productivity, avoidance of illness and injury risks, and increased satisfaction among the workforce. Although the scope of ergonomics is much broader, the term here refers to assessing those work-related factors that may pose a risk of musculoskeletal disorders and recommendations to alleviate them. Common examples of ergonomic risk factors are found in jobs requiring repetitive, forceful, or prolonged exertions of the hands; frequent or heavy lifting, pushing, pulling, or carrying of heavy objects; and prolonged awkward postures. Vibration and cold may add risk to these work conditions.

Public Health Core functions of Public Health A population-based approach to healthy living Core functions of Public Health Assessment Policy Development Assurance Public health services are population based. That means that public health services are focused on improving the health of the overall population, as opposed to primary care providers who treat individuals. The responsibility of local health departments is to protect and promote health, and prevent disease and injury. To accomplish this mission, public health departments focus on three core functions; assessment, policy development, and assurance. The functions are essential to the maintenance of population-based services. The first function is assessment. Local health departments work closely with various community groups and organizations to identify and evaluate health needs and health hazards in the greater community. Second is policy development. Again, in conjunction with the community, public health professionals help prioritize health needs, plan how to address these needs, and are active advocates for the programs, policies, or laws which will assure the top health needs are met. The third core function is assurance. Our public health network continually evaluates health programs and policies to make sure priority health needs are being met in a way that supports local goals and objectives.

Assessment Assess community health needs Investigate health hazards and effects Analyze health factors Assessment is the first core function. There are three essential services within Assessment. Your local public health department assesses the health needs of the community and, in cooperation with other health agencies, collects information on the public health status of the community. This includes areas such as community health needs, environmental health, epidemiologic, and other studies of health problems. Your health department also investigates the occurrence of health hazards and their effects. We work closely with the community to gather more detailed information on the magnitude of each health issue, gathering facts on the problem—such as duration, trends, location, population at risk, and ideas on how best to proceed to prevent or control the problem. To analyze the determinants of identified health needs, public health professionals examine etiologic, risk, and other factors that precede or contribute to specific health problems in the community. Identifying these factors helps the community plan intervention for prevention or control.

Policy Development Advocate for community needs and issues Prioritize health needs Plan and develop policies Policy Development is the second core function. There are three essential services within Policy Development. Advocacy is the process of generating support among constituent groups that address community health needs and issues. Local health departments work to establish collaborative relationships between the public health agency, the community we serve, the government offices we represent, and other health and human-related organizations in the community. We work with the community to prioritize health needs according to their importance, the seriousness of the consequences, the economic impact, and community readiness to prevent or control the problem. Working with community groups, we help formulate goals and objectives to meet the priority health needs of the community and plan a course of action to achieve the goals and objectives in a way that is responsive to local needs.

Assurance Manage resources Implement programs Evaluate programs Inform the public Assurance is the third core function. There are four essential services within Assurance. Each local health department works with various community groups to acquire, allocate, and manage resources required to meet priority community health needs. Resources include people, facilities, equipment and funds. We work with other organizations, agencies and individuals to assure the implementation of programs that support community priorities. We also work with the community to change community policy, practice or mores. Public health professionals evaluate programs and provide quality assurance through a process of continuous inquiry to determine the efficiency and effectiveness of efforts so that corrections can be made to improve activities and outcomes. We develop processes of informing the community about health problems and the availability of services. Our goal is to gain the attention of individuals and high-risk groups, and to offer education which provides the knowledge and skills to promote good health and healthy lifestyles for individuals and the community as a whole.