1. Component 1: Introduction to Health Care and Public Health in the U.S.
1.1: Unit 1: Introduction to modern healthcare in the US
1.1 b: Introduction to Public health
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

2. Health IT Workforce Curriculum Version 1.0/Fall 2010
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."
C.E. A. Winslow, “The Untilled Fields of Public Health,” Science, n.s. 51 (1920), p. 23
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

3. 10 Great Public Health Achievements – US, 1900-1999
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
CDC. Ten great public health achievements—United States, 1900–1999. MMWR 1999;48:241–3.
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

4. 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
Chicago typhoid rates at
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

5. Public Health Successes (continued)
Control of infectious diseases
Example: Smallpox
Epidemic viral illness, possibly responsible for hundreds of millions of deaths in the 20th 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
From
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

6. 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 2010

7. 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 2010

8. 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
Definition of epidemiology from Principles of Epidemiology, 2nd edition, CDC Self Study Course 3030-G at
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

9. 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 2010

10. 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 2010

11. 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 2010

12. 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
Vandenbroucke JP. Clinical investigation in the 20th century: the ascendency of numerical
reasoning. Lancet 1998;352(suppl 2):12–6.
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010

13. How has public health improved healthcare? (continued)
Improvement in training
Establishment of many schools of public health in the early 20th century
Professional degrees such as Master of Public Health (M.P.H.)
Improvements in infrastructure
Federal
State
Local health departments
Turnock BJ. The organization of public health in the United States. In: Turnock BJ, ed. Public
health: What it is and how it works. Gaithersburg, Maryland: Aspen Publication, 1997:1121–68.
Component 1 / Unit 1
Health IT Workforce Curriculum Version 1.0/Fall 2010