What is Public Health? Allyson Hall, PhD Department of Health Services Research, Management, and Policy College of Public Health and Health Professions November 28, 2007

WHO’s Definition of Health HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY WHO, 1946

An Ecological Model of Health An Ecological Model: An Ecological Model:  multiple determinants of health  linkages and relationships among determinants are emphasized

Source: Institute of Medicine, 2003 Determinants of Population Health: The Ecological Model Psychosocial factors Employment status and occupational factors Socioeconomic status Natural and built environments Public health and health care services

Assumptions about Public Health Public health problems are multi- causal Public health problems are multi- causal Personal, group and population ‘behaviors’ are related to public health problems Personal, group and population ‘behaviors’ are related to public health problems Behaviors are influenced by a wide range of factors Behaviors are influenced by a wide range of factors

Public Health’s Mission Protecting health on a population level Social justice emphasis

Health Promotion and Prevention Recognized as a means to meet public health objectives and improve public health interventions Concerned with : Changing individuals and groups behavior Changing individuals and groups behavior Improving their social environment Improving their social environment

Health Promotion and Health Behavior Research and Practice Strives to: Help people adopt new behaviors Help people adopt new behaviors Help people cease old behaviors Help people cease old behaviors Reinforce healthy behavior Reinforce healthy behavior Ensure a supportive and healthy environment Ensure a supportive and healthy environment

Measles TB Pneumonia Diphtheria Scarlet Fever Typhoid Influenza Whooping Cough Polio The Fall in the Standardized Death Rate (per 1,000) for Nine Common Infectious Diseases in Relation to Specific Medical Measures, US Source: McKinlay and McKinlay, 1977

Source: Centers for Disease Control and Prevention MMWR, 1999 Motor-vehicle related deaths per 100,000 population and per 100 million vehicle miles traveled

Ten Great Public Health Achievements – United States, Control of infectious disease Control of infectious disease Vaccination Vaccination Motor-vehicle safety Motor-vehicle safety Safer workplaces Safer workplaces Declines in death from coronary heart disease and stroke Declines in death from coronary heart disease and stroke Safer and healthier food Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco as health hazard Centers for Disease Control and Prevention, MMWR, 1999

The Essential Public Health Services 1. Monitor health status to identify community health problems. 2. Diagnose and investigate health problems and health hazards in the community 3. Inform, educate and empower people about health issues 4. Mobilize community partnerships to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts 6. Enforce laws and regulations that protect health and ensure safety 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable 8. Assure a competent public health and personal health care workforce 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10. Research for new insights and innovative solution to health problems Source: Public Health Function Steering Committee

In a nutshell…. Public Health Science Defines the problem (the who) Identifies risk factors for the disease (the why) Develops and implements interventions Measures effectiveness Assessment Policy Development & Program Implementation Assurance

Core Public Health Areas Epidemiology Biostatistics Environmental Health Health Services Administration/Health Policy Social and Behavioral Sciences

The Public Health System Community Health care delivery system Employers & Business Governmental Public Health Infrastructure Academics The Media Assuring the Conditions for Population Health Source: Institute of Medicine, 2002

The Government Public Health Infrastructure Local Health Departments State Health Departments Department of Health and Human Services Centers for Disease Control and Prevention National Institutes of Health Health Resources and Services Administration Food and Drug Administration

Jobs in Public Health Health educator Epidemiologist Health policy analyst Community organizer/activist/advocate Public health department director Occupational health and safety expert Food safety expert Public health lawyer

In conclusion… There is much work to be done……

Leading Causes of Death for Males by Race and Hispanic Origin, United States 2001 All Races WhiteBlackHispanic All Ages Diseases of the heart 1-14AccidentsAccidentsAccidentsAccidents 15-19AccidentsAccidentsHomicideAccidents 20-24AccidentsAccidentsHomicideAccidents 25-34AccidentsAccidentsHomicideAccidents 35-44AccidentsAccidents Accidents CancerCancerCancerCancer 65+ Source: National Center for Health Statistics, Health United States, 2003

Actual Causes of Death in the United States, 2000 Source: Mokdad et al, 2004 Percent of all deaths

Percent Adult Current Smokers*, by selected characteristics: United States Source: National Center for Health Statistics, Health United States, 2003 *Smoked at least 100 cigarettes in lifetime and currently smokes

Percent of Women Who Are Overweight*, by Selected Characteristics: United States Source: National Center for Health Statistics, Health United States, 2003 *BMI greater than or equal to 25

Master of Public Health Program 1 course in each of the 5 core areas of public health 3-9 courses in a core area of concentration Public health electives Internship Seminar in Contemporary Public Health Issues