Component 1: Introduction to Health Care and Public Health in the U.S. Unit 1: Introduction to modern healthcare in the US Introduction to Public health Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20101

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." Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20102

10 Great Public Health Achievements – US, Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20103

Public Health Successes (continued) Control of infectious diseases ◦ Example: Typhoid  spread by ingesting contaminated food or water  In 1891 the typhoid death rate in Chicago alone was 174 per 100,000 people.  Now, thanks to public health measures only about 400 cases are seen in the US each year, most of whom originate when patients travel in developing countries Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20104

Public Health Successes (continued) Control of infectious diseases ◦ Example: Smallpox  Epidemic viral illness, possibly responsible for hundreds of millions of deaths in the 20 th century alone  In the early 1950s there were about 50 million cases of smallpox each year worldwide  By 1977, smallpox was eradicated, thanks to an aggressive public health program and the use of an effective vaccine Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20105

Public Health Successes (continued) Control of nutritional deficiencies ◦ Example: Goiter  Lack of iodine in diet leads to impaired thyroid hormone synthesis and an enlargement of the thyroid gland in the neck (a goiter)  Fortification of salt with iodine virtually eradicated nutritional goiter in the US Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20106

Public Health Successes (continued) Control of nutritional deficiencies ◦ Example: Tooth Decay  Adding fluoride to drinking water substantially reduces the incidence of dental caries (tooth decay) in populations  In 1945 fluoride was added to water in Grand Rapids, Michigan, which resulted in a reduction in cavities.  Now over 10,000 US communities fluoridate their water Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20107

How has public health improved healthcare? Improvements in understanding disease ◦ Epidemiology is considered the basic science of public health and is  a quantitative basic science  a method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality  a tool for public health action to promote and protect the public’s health Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20108

How has public health improved healthcare? Improvements in understanding disease ◦ An example of epidemiology at work:  In epidemic of cholera in London, England.  Cholera is a bacterial disease spread by contamination of food or water  Lack of sanitation and overcrowding -- important factors that led to the spread of disease  Spread of disease linked to a contaminated public water pump by Dr John Snow  Snow’s hypothesis: cholera was spread by contaminated water Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 20109

How has public health improved healthcare? (continued) Improvements in data collection ◦ Original methods of data collection were crude ◦ progressive improvement in methodology led to the use of sophisticated scientific methods to collect data  cohort studies  randomized control trials Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall

How has public health improved healthcare? (continued) Improvements in data collection Example: the Framingham Heart Study The study followed patients for a number of years to identify factors that contribute to the development of cardiovascular disease (CVD) Over the years, three generations of participants have helped identify major CVD risk factors Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall

How has public health improved healthcare? (continued) Improvements in data analysis (use of tools such as multivariate analysis and metaanalysis) Improvement in disease surveillance ◦ Example: the Real-Time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh, Department of Biomedical Informatics Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall

How has public health improved healthcare? (continued) Improvement in training ◦ Establishment of many schools of public health in the early 20 th century ◦ Professional degrees such as Master of Public Health (M.P.H.) Improvements in infrastructure ◦ Federal ◦ State ◦ Local health departments Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall