2. Introduction What Is Public Health’s Role in Addressing Outbreaks of Disease? How Are Public Health Agencies Involved in Protecting Against Terrorism and Bioterrorism? What Can We Learn from the Mistakes of the Past?

3. Introduction What Is Systems Thinking and How Can It Improve Public Health Efforts? How Can Systems Thinking Approaches Be Applied to Food Safety? How Can an Educated Citizenry Make the 21st Century Different for Public Health?

4. Scenarios The Future of Population Health It is 2015 and you are working at a large organization that provides its own cafeteria services where most employees each lunch. An outbreak of an acute diarrhea occurs among those who eat in the cafeteria. The company calls in the local health department. To your surprise they cannot identify a known cause and request help from the CDC’s Epidemic Intelligence Service (EIS). You are quite impressed when the EIS detects a never before recognized strain of toxin producing E. coli and sends out a worldwide alert. You wonder could this be a bioterrorism attack or just a routine outbreak? The “all hazards” team assures you that this is just routine and that we’re making progress. Now that a systems approach is in place only 10% of American’s suffer foodborne illness each year. Back in the early 21st century it was more like 25%.

5. Scenarios The Future of Population Health It is 2025 and the worst predictions about infectious disease have come true. It seems like everyday there is a new outbreak of drug resistant infection. New technology has allowed us to get the word out instantly and mount rapid campaigns to control the infection and develop vaccines to protect those at greatest risk. Clean water is increasingly scarce and infectious disease outbreaks are emerging throughout the world as nations compete for the remaining sources of clean water. You worry about your child who is about to be born into a new world of emerging infections.

6. Scenarios The Future of Population Health It is 2035 and you are now middle aged. The epidemic of obesity has reached your waist line and you have high cholesterol, high blood sugar, and high blood pressure. Fortunately cigarettes are history but heart disease and strokes are making a comeback as the number one killer. It seems like everyone is having surgery to treat their obesity and look better but you wonder if there just might be a better approach. In other ways the world is beginning to come to grips with problems including the pressures of population growth and environmental deterioration. You begin to see hope for the future.

7. Scenarios The Future of Population Health It is 2055 and by now you thought you’d be getting ready for retirement. Now you look ahead to working until you are 75 or maybe 80. Life- expectancy at birth is now approaching 90 so the retirement age is going up too. You’re delighted that people are living longer but you still hope that a cure for Alzheimer’s will come along soon. It seems like people are living longer but are they living better? The world has agreed to put a limit on what it spends on those over 85 and instead invest in new technology to deal with global warming.

8. Scenarios The Future of Population Health It is 2076 and you are about to celebrate the 300th birthday of the United States. There is a lot to celebrate. Economic progress has spread throughout the world and the population health approach has greatly improved the quality as well as the quantity of life. Technology has produced a cure for Alzheimer’s and many other diseases. Global warming turned out to be a real challenge but the global cooperation that it produced has positive effects. HIV/AIDS is still with us but it is now seen as a chronic disease that people live with instead of dying from. New challenges continue to face you as you look ahead. However, now that there is a health system that uses a systems thinking approach and an educated citizenry that understands public health problems and approaches, you are confidence about the future.

9. Levels of Public Health Coordination Needed for successful Food Safety LevelOrganizations involvedRoles Global The Food and Agriculture Organization of The United Nations (FAO) The United Nations agency with overall responsibility for the food supply with special emphasis on ensuring an adequate supply of food worldwide The World Health Organization (WHO) Not a regulatory agency, but establishes policy and makes recommendations regarding the safety of the world food supply through its Food Safety Department (FOS)

10. Levels of Public Health Coordination Needed for successful Food Safety LevelOrganizations involved Roles Global The Codex Alimentarius Commission (CAC) Initiated as a joint program of FAO and WHO that develops food standards, guidelines, and codes of practice. These now form the basis for the rules of global trade under the jurisdiction of the World Trade Organization (WTO)

11. Levels of Public Health Coordination Needed for successful Food Safety LevelOrganizations involved Roles Federal The United States Food and Drug Administration (FDA) Overall regulatory responsibility for food safety regulation in the United States The United States Department of Agriculture (USDA) Regulatory responsibilities for meat, poultry, and eggs in the United States

12. Levels of Public Health Coordination Needed for successful Food Safety LevelOrganizations involved Roles Federal The United States Environmental Protection Agency (EPA) Regulation of pesticide usage and the establishment of water quality standards The Centers for Disease Control and Prevention (CDC) Not a regulatory agency, but responsible for ongoing surveillance, as well as acute investigation in collaboration with state and local health department

13. Levels of Public Health Coordination Needed for successful Food Safety LevelOrganizations involved Roles State/Local State and local health departments Restaurant inspections Consumer Consumer protection agencies Education in safe food purchasing, preparation, and storage

14. Population Pyramid Expected for Nigeria U.S. Census Bureau, International Data Base 2000 and 2025

15. Population Pyramid expected for Japan U.S. Census Bureau, International Data Base 2000 and 2025

16. Population Pyramid expected for the United States U.S. Census Bureau, International Data Base 2000 and 2025