Public Health Overview Sam Stebbins, MD, MPH San Mateo County Public Health sstebbins@co.sanmateo.ca.us

What is Public Health? The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Public health is the organised response by society to protect and promote health and to prevent illness, injury and disability Public health is community health. It has been said that: "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.” What is Public Health?   The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Public Health is the organized response by society to protect and promote health and to prevent illness, injury and disability. Public Health is community health. It has been said that: “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.” Disease reporting in San Mateo County: Call (650) 573 – 2346 (regular hours) Call (650) 363 – 4981 (after hours – urgent needs) Fax (650) 573 – 2919 San Mateo County Health Department: www.smhealth.org What diseases to report and how to report them Restaurant inspection results Beach and stream water quality How to dispose of household hazardous wastes Local and state bioterrorism and disaster resources Local Data: www.plsinfo.org/healthysmc/ Immunizations: www.immunize.org/ American Public Health Association: www.apha.org Infectious Disease Resources: Avian Influenza: www.cdc.gov/flu/avian/index.htm l Bioterrorism: www.bt.cdc.gov/ Influenza: www.cdc.gov/flu/ SARS: www.cdc.gov/ncidod/sars/ STDs: www.cdc.gov/STD/treatment/ Tuberculosis: www.ctca.org West Nile Virus: http://westnile.ca.gov/links.htm

What is Public Health? …what society does collectively to assure the conditions for people to be healthy. The health of the population is the focus of public health efforts. It is not dissimilar to your own relationship to your doctor, except in this case the “you” is everybody. “The health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development and health services.”

Local Public Health System Voluntary Agencies Social Services Churches Nursing Facilities Home Health MDs Group Practices MCO Group Practices Hospitals Health Department MCOs Nursing Facilities Employers MCO Hospitals MCO MDs Schools Drug Treatment Mental Health

Public Health is the ultimate systems challenge Through his "INVENTIONS", Rube Goldberg discovered difficult ways to achieve easy results. His cartoons were, as he said, symbols of man's capacity for exerting maximum effort to accomplish minimal results. Rube believed that there were two ways to do things: the simple way and the hard way, and that a surprisingly number of people preferred doing things the hard way. Rube Goldberg (1883-1970) was a Pulitzer Prize winning cartoonist, sculptor, and author. Reuben Lucius Goldberg (Rube Goldberg) was born in San Francisco. His father, a practical man, insisted he go to college to become an engineer. After graduating from University of California Berkeley, Rube went to work as an engineer with the City of San Francisco Water and Sewers Department.

The “Web” of Causality What is the cause? Necessary factors Augmenting factors The pedestrian, struck by an automobile and dying with a ruptured spleen shortly after admission to the hospital, is an example. The pathologist may ascribe the death to splenic rupture, the internist to shock, the surgeon to delay in diagnosis in the admitting room. The Registrar of Vital Statistics may be content to assign the death to “MVA involving pedestrian.” The highway engineer may attribute the death to lack of adequate separation of pedestrian and vehicular traffic, while the engineer responsible for automobile design may count the case among those due to brake failure. Others may point out that the death would not have occurred if the victim had been 25 rather than 65 or if his reaction time had not been seriously reduced by alcohol. Each professional observer has selected a different contingency in relation to their own point of view. Each classification is as valid as another because it is useful for the particular purpose the professional worker had in mind.

10 greatest public health achievements of the 20th century Safer Foods Healthier Mothers and Babies Family Planning Fluoridation of Drinking Water Tobacco Reduction Vaccination Motor Vehicle Safety Safer Workplaces Control of Infectious Diseases Decreased deaths from heart disease and stroke Vaccination – that’s pretty medical. So is Control of ID.

Sam SMC is a county of 450 square miles, about 1/3 the size of Rhode Island. Bounded to the North by SF, West by the Pacific, East by SF Bay and South by Santa Cruz and Santa Clara counties. West and South (the yellow part of the map) is mostly open space with sparse population and very limited road access. Population is approximately 725,000, with tremendous diversity – 50% Caucasian, 20% Hispanic, 21% Asian/Filipino/Pacific Islander.

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 Dottie Right brain activity – this has been the most fun so far!

The 3 Kinds of Prevention Primary Prevention Secondary Prevention Tertiary Prevention

What is “pre-diabetes”? Impaired Glucose Tolerance Impaired fasting glucose 110-125 mg/dL Greater than “normal” but less than > 126 which is diagnostic of diabetes

I. Role of the Public Health Laboratory 1. To provide laboratory tests for the various program units of the health department 2. To assist in the diagnosis, control, and prevention of communicable diseases and other illnesses of public health concern 3. To provide specialized knowledge in public health microbiology for the purpose of consultation with other specialists in the county

II. Practices of P.H. Laboratory A. To provide laboratory services 1. STD control 2. TB control 3. CD control 4. Environmental Health 5. Zoonotic disease control 6. Epidemiological investigations 7. Educational activities

Nuestro Canto de Salud -Our Song of Health – Bridging medical expertise and community outreach to implement culturally/linguistically appropriate health care services. Partners Goals & Objectives Strategies Community Focused

Chronic Disease Management Team Health Promoters (Promotores de Salud) Community & Street Outreach Community Presentations/Events Resource referrals Community screenings Community Health Workers Clinical Team (RN/RD/CDE)

Strategies Demystify health through training & field experience Utilize natural support networks & environments Community access to prevention & intervention Link to needed medical care

Definition Epidemiology is The study of the distribution and determinants of health related states or events in specified populations, and The application of this study to the control of health problems

Objectives of Epidemiology Identify cause of a disease and risk factors Determine extent of disease found in a community Study the natural history and prognosis of disease Evaluate existing and new preventive and therapeutic measures Provide foundation for developing public policy and regulatory decisions

Distribution: Descriptive Epidemiology The frequency and pattern of health events in a population The who, what, where, when, and how many

Determinants: Analytic Epidemiology The how and why Do schools with snack and soda machines have higher rates of obesity than schools without? Do smokers have higher rates of lung cancer than nonsmokers?

Prevalence Proportion of persons in a population that has disease Number of persons with condition at a given time Number of persons in the population at that time

Prevalence of Obesity among U.S. Adults, BRFSS, 1993 <10% 10-15% >15% N/A Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity among U.S. Adults, BRFSS, 1996 <10% 10-15% >15% N/A Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.

Prevalence of Obesity among U.S. Adults, BRFSS, 1999 <10% 10-15% >15% N/A Source: Mokdad A H, et al. Am Med Assoc 2000;284:13

Incidence Proportion of a population at risk that becomes diseased over a specified period of time Number of new events during a given time ______________ Number of people at risk during a given time

Test Characteristics Is the test useful? Will it accurately identify who really does and does not have the condition?

Testing: Sensitivity The proportion of people with disease who are correctly identified as such by the test The probability of a positive test if disease is present Is the test sensitive enough to find everyone with the condition?

Testing: Specificity The proportion of people without disease who are correctly identified as such The probability of a negative test if disease is absent Is a positive test result specific to this disease, identifying only people who truly have it?

Modes of transmission Direct Direct contact (kissing, skin-to-skin, sexual intercourse) Droplet spread Vertical transmission

Modes of transmission Indirect Airborne (dust, droplet nuclei) Vehicle-borne (food, water, soil, bio product, fomites) Vector-borne (mechanical, biological)

What is an outbreak? Outbreak (AKA epidemic) – the occurrence of cases of an illness clearly in excess of expectancy for a given time period Endemic – persistent or baseline level of disease; the level of disease usually present in a community (not necessarily the preferred level) Pandemic – when an epidemic spreads over several countries or continent (the Spanish flu pandemic of 1918)

Why Investigate an Outbreak? To identify additional unreported or unrecognized cases To control the spread of disease To identify the source or vehicle of infection (to control or eliminate it) To learn more about the disease itself (natural history of disease, clinical spectrum, descriptive epidemiology, and risk factors)

Really Useful Information Disease Reporting in San Mateo County: Call (650) 573-2346 (regular hours) Call (650) 363- 4981 (after hours – urgent needs) Fax (650) 573 - 2919 San Mateo County: www.smhealth.org What diseases to report and how to report them Restaurant inspection results Beach and stream water quality testing How to dispose of household hazardous wastes Local/State bioterrorism and disaster resources Local Data: www.plsinfo.org/healthysmc/ Immunizations: http://www.immunize.org/ American Public Health Assoc: www.apha.org