1. The Foundational Principles of Public Health Practice in the United States
Anbesaw W. Selassie, MPH, DrPH
Associate Professor
Biostatistics and Epidemiology
Department of Medicine
Medical University of South Carolina

2. Learning Objectives
By the end of the session, class participants will be able to:
Define public health
Define the core functions of public health
Provide examples for key public health activities
Describe the components of public health system

3. Prologue to Public Health
Always in the news but not labeled as “public health news”
Example of four major public health stories in the news
The AIDS epidemic
H1N1 (Swine Flu)
Outbreak of water-borne disease in Milwaukee with 403,000 sick, WI 1993 (C. parvum)
Collapse of Public Health in Russia
The 9/11 terrorist attack

4. What is Public Health? Public health is the science and art of:
(C-E A. Winslow, 1923)
Public health is the science and art of:
Preventing diseases
Promoting health and efficiency
Prolonging life

5. What is Public Health? (Continued…)
The processes by which the objectives of Public Health are attained:
Creation/maintenance of clean environment
Control of infectious diseases
Education and promotion of personal health
Organization of medical and nursing services for early diagnosis and treatment
Promotion of the social system which will ensure every individual a standard of living adequate for maintenance of health.

6. Mission of Public Health in the US
To promote physical and mental health and prevent disease, injury, and disability
The US Public Health System comprises a wide array of governmental and non-governmental entities

7. Entities of the US PH System
59 state and territorial health departments
3,000 county and city health departments
>160,000 public and private laboratories
Parts of multiple federal dept and agencies
Tribal health departments
Hospitals and other healthcare providers
Volunteer organizations (E.g., Red Cross)

8. The Substance of Public Health
The substance of public health is “organized community efforts aimed at the prevention of disease and promotion of health”

9. Organizational Framework of Public Health System in the US
Partnerships of:
Public Organizations (DHEC, DHHS, DDSN, etc.)
Private and Voluntary Organizations (United Way, Salvation Army, Ryan White Clinic, etc.)
Individuals

10. The Foundations of Public Health
The philosophical base
Social Justice- for defining disparities and inequity in health (extension of Herbert Spencer’s Social Darwinism)
The science base
Epidemiology- for defining problems, developing interventions, and measuring results
William H. Foege, MD, MPH
JAMA, 1993; 270:251

11. Core Functions of the US PH System
The Institute of Medicine Report on the “Future of Public Health” in 1988, identified the core functions of Public Health as,
Assessment
Policy development
Assurance
Assessment
Assurance
Policy Development
Public Health Practice

12. Medical Care vs. Public Health
Medical Care Public Health
Focuses on healing Focuses on preventing
Individual patient Community as patient
Patient assessment Community assessment
Rx plan to cure sick Relies on policy development
Assures Rx is taken Assures service is available
Outcome recognizable Outcome hard to recognize
Rewarded/well-funded Under-funded/unappreciated
84% of health-care cost % of health-care cost
Cost-prohibitive Cost-effective
Knowledge intensive Effort intensive

13. US National Health Expenditure, 2008
$2.339 trillion
Where it came from
Where it went

14. National Health Care Expenditure, 1999-2008
83.47
83.33
83.45
83.49
83.53
83.42
83.64
84.28
84.21
84.40
% of Total Exp
3.22
3.18
3.21
3.27
3.09
2.90
2.84
2.87
2.89
2.97
53.6B
69.4B
40.7B

15. Changes in life expectancy
Life expectancy of Americans increased from 48 to 78 between 1900 and 2000.
Only 5 of the 30 years are accounted by improvement in medical care (JAMA. 1999;281(16): )
Medical care
Public Health

16. The Science of Public Health
Relies on the various disciplines that provide the basis for public health practice
Epidemiology
Biostatistics
Environmental health
Microbiology (Public Health Laboratory)
Public health education/Health Promotion
Health Policy and Management

17. The Public Health Approach to Prevention
Implementation
How do you do it?
Intervention
Evaluation
What works?
Risk Factors
What is the cause?
Surveillance
What is the
problem?
Problem
Response

18. Prioritization of Healthcare Issues in the US Public Health Planning
Morbidity: Incidence/Prevalence (E.g. Flu)
Mortality:  Death Rate (E.g. AIDS)
Case Fatality Rate:  Recovery (E.g. Rabies)
Lost Productivity:  Loss (E.g. CNS Injuries)
Preventability:  Preventable (E.g. Polio)
Medical Cost :  Cost (E.g. TSCI)
Premature Mortality:  YPLL (E.g. Firearm)
Wide Disparity: Prostate Ca in AA

19. Epidemiology
Epidemiology is the study of the distribution and determinants of health, disease, injuries, and disability in populations.
John Last, A Dictionary of Epidemiology, 1995
The goal of epidemiological research is to provide the scientific basis for developing rational measures of prevention and control

20. Public Health Statistics
In the context of public health, statistics is the collection, summarizing, and analyzing of data that are subject to random variation and uncertainties.
Public health data are collected on vital events such as births, deaths, marriages, divorces, fetal deaths, and causes of death and diseases.
The science of statistics is used to calculate risks from exposure and determine the degree to which rates vary in population groups.

21. Environmental Health
The study of the effect on human health of physical, chemical, and biological factors in the external environment.
It is mainly concerned with preventing the spread of disease through water, air, and food
Modern day challenges, however, include chemicals, radiations, environmental pollution, and global warming.

22. Microbiology
In the context of public health practice, microbiology refers to the investigation of the spread of infectious agents, their toxins, and how they affect the human body.
It is mainly concerned with establishing the diagnosis of an outbreak and tracking the sources of the agents
It is an integral part of infectious disease epidemiology

23. Health Education/Health Promotion
Health Education refers to the process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance, and restoration of good health.
Health Promotion refers to the process of enabling people to increase control over and improve their health. It involves the population as a whole in the context of their everyday lives to improve their health.

24. Health Policy/Health Management
The study of the healthcare and medical care systems concerning runaway costs, access to care, and quality of services provided by an organized health delivery system.
Health services research is primarily involved in assessing the effectiveness, efficiency, and equity of a healthcare system.
It uses epidemiologic, sociological, economic, and analytic sciences in the study of health services.

25. Source/Reference
Schneider MJ. The Sciences of Public Health. In: Introduction to Public Health. Ch.1, pp 1-15, Jones & Bartlett, Boston, 2006.
Last JM (ed). A dictionary of epidemiology, 3rd ed. Oxford Publication, 1995
Wallace RB (ed). Public Health Methods. In: Maxcy-Rosenau-Last Public Health & Preventive Medicine. Section 1, Appleton & Lange Publication. 14th ed., 1998