1. Public Health Overview
Sam Stebbins, MD, MPH
San Mateo County Public Health

2. What is Public Health?
The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society.
Public health is the organised response by society to protect and promote health and to prevent illness, injury and disability
Public health is community health. It has been said that: "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.”
What is Public Health?
The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society.
Public Health is the organized response by society to protect and promote health and to prevent illness, injury and disability.
Public Health is community health. It has been said that: “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.”
Disease reporting in San Mateo County:
Call (650) 573 – 2346 (regular hours)
Call (650) 363 – 4981 (after hours – urgent needs)
Fax (650) 573 – 2919
San Mateo County Health Department:
What diseases to report and how to report them
Restaurant inspection results
Beach and stream water quality
How to dispose of household hazardous wastes
Local and state bioterrorism and disaster resources
Local Data:
Immunizations:
American Public Health Association:
Infectious Disease Resources:
Avian Influenza: l
Bioterrorism:
Influenza:
SARS:
STDs:
Tuberculosis:
West Nile Virus:

3. What is Public Health?
…what society does collectively to assure the conditions for people to be healthy.
The health of the population is the focus of public health efforts. It is not dissimilar to your own relationship to your doctor, except in this case the “you” is everybody.
“The health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development and health services.”

4. Local Public Health System
Voluntary Agencies
Social Services
Churches
Nursing Facilities
Home Health
MDs
Group Practices
MCO Group Practices
Hospitals
Health Department
MCOs
Nursing Facilities
Employers
MCO Hospitals
MCO MDs
Schools
Drug Treatment
Mental Health

5. Public Health is the ultimate systems challenge
Through his "INVENTIONS", Rube Goldberg discovered difficult ways to achieve easy results. His cartoons were, as he said, symbols of man's capacity for exerting maximum effort to accomplish minimal results. Rube believed that there were two ways to do things: the simple way and the hard way, and that a surprisingly number of people preferred doing things the hard way.
Rube Goldberg ( ) was a Pulitzer Prize winning cartoonist, sculptor, and author.
Reuben Lucius Goldberg (Rube Goldberg) was born in San Francisco. His father, a practical man, insisted he go to college to become an engineer. After graduating from University of California Berkeley, Rube went to work as an engineer with the City of San Francisco Water and Sewers Department.

6. The “Web” of Causality What is the cause? Necessary factors
Augmenting factors
The pedestrian, struck by an automobile and dying with a ruptured spleen shortly after admission to the hospital, is an example. The pathologist may ascribe the death to splenic rupture, the internist to shock, the surgeon to delay in diagnosis in the admitting room. The Registrar of Vital Statistics may be content to assign the death to “MVA involving pedestrian.” The highway engineer may attribute the death to lack of adequate separation of pedestrian and vehicular traffic, while the engineer responsible for automobile design may count the case among those due to brake failure. Others may point out that the death would not have occurred if the victim had been 25 rather than 65 or if his reaction time had not been seriously reduced by alcohol.
Each professional observer has selected a different contingency in relation to their own point of view. Each classification is as valid as another because it is useful for the particular purpose the professional worker had in mind.

7. 10 greatest public health achievements of the 20th century
Safer Foods
Healthier Mothers and Babies
Family Planning
Fluoridation of Drinking Water
Tobacco Reduction
Vaccination
Motor Vehicle Safety
Safer Workplaces
Control of Infectious Diseases
Decreased deaths from heart disease and stroke
Vaccination – that’s pretty medical. So is Control of ID.

8. Sam
SMC is a county of 450 square miles, about 1/3 the size of Rhode Island.
Bounded to the North by SF, West by the Pacific, East by SF Bay and South by Santa Cruz and Santa Clara counties. West and South (the yellow part of the map) is mostly open space with sparse population and very limited road access.
Population is approximately 725,000, with tremendous diversity – 50% Caucasian, 20% Hispanic, 21% Asian/Filipino/Pacific Islander.

9. MASS PROPHYLAXIS
The ability to provide antibiotics, vaccination and/or medical triage to all residents of San Mateo County in an emergency as quickly and effectively as possible
Dottie
Right brain activity – this has been the most fun so far!

11. The 3 Kinds of Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention

12. What is “pre-diabetes”?
Impaired Glucose Tolerance
Impaired fasting glucose
mg/dL
Greater than “normal” but less than > 126 which is diagnostic of diabetes

13. I. Role of the Public Health Laboratory
1. To provide laboratory tests for the various program units of the health department
2. To assist in the diagnosis, control, and prevention of communicable diseases and other illnesses of public health concern
3. To provide specialized knowledge in public health microbiology for the purpose of consultation with other specialists in the county

14. II. Practices of P.H. Laboratory
A. To provide laboratory services
1. STD control
2. TB control
3. CD control
4. Environmental Health
5. Zoonotic disease control
6. Epidemiological investigations
7. Educational activities

15. Nuestro Canto de Salud -Our Song of Health –
Bridging medical expertise and community outreach to implement culturally/linguistically appropriate health care services.
Partners
Goals & Objectives
Strategies
Community Focused

16. Chronic Disease Management Team
Health Promoters (Promotores de Salud)
Community & Street Outreach
Community Presentations/Events
Resource referrals
Community screenings
Community Health Workers
Clinical Team (RN/RD/CDE)

17. Strategies Demystify health through training & field experience
Utilize natural support networks & environments
Community access to prevention & intervention
Link to needed medical care

18. Definition Epidemiology is
The study of the distribution and determinants of health related states or events in specified populations, and
The application of this study to the control of health problems

19. Objectives of Epidemiology
Identify cause of a disease and risk factors
Determine extent of disease found in a community
Study the natural history and prognosis of disease
Evaluate existing and new preventive and therapeutic measures
Provide foundation for developing public policy and regulatory decisions

20. Distribution: Descriptive Epidemiology
The frequency and pattern of health events in a population
The who, what, where, when,
and how many

21. Determinants: Analytic Epidemiology
The how and why
Do schools with snack and soda machines have higher rates of obesity than schools without?
Do smokers have higher rates of lung cancer than nonsmokers?

22. Prevalence Proportion of persons in a population that has disease
Number of persons with condition at a given time
Number of persons in the population at that time

24. Prevalence of Obesity among U.S. Adults, BRFSS, 1993
<10% % >15% N/A
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.

25. Prevalence of Obesity among U.S. Adults, BRFSS, 1996
<10% % >15% N/A
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.

26. Prevalence of Obesity among U.S. Adults, BRFSS, 1999
<10% % >15% N/A
Source: Mokdad A H, et al. Am Med Assoc 2000;284:13

28. Incidence
Proportion of a population at risk that becomes diseased over a specified period of time
Number of new events during a given time
______________
Number of people at risk during a given time

29. Test Characteristics Is the test useful?
Will it accurately identify who really does and does not have the condition?

30. Testing: Sensitivity
The proportion of people with disease who are correctly identified as such by the test
The probability of a positive test if disease is present
Is the test sensitive enough to find everyone with the condition?

31. Testing: Specificity
The proportion of people without disease who are correctly identified as such
The probability of a negative test if disease is absent
Is a positive test result specific to this disease, identifying only people who truly have it?

32. Modes of transmission Direct
Direct contact (kissing, skin-to-skin, sexual intercourse)
Droplet spread
Vertical transmission

33. Modes of transmission Indirect Airborne (dust, droplet nuclei)
Vehicle-borne (food, water, soil, bio product, fomites)
Vector-borne (mechanical, biological)

34. What is an outbreak?
Outbreak (AKA epidemic) – the occurrence of cases of an illness clearly in excess of expectancy for a given time period
Endemic – persistent or baseline level of disease; the level of disease usually present in a community (not necessarily the preferred level)
Pandemic – when an epidemic spreads over several countries or continent (the Spanish flu pandemic of 1918)

35. Why Investigate an Outbreak?
To identify additional unreported or unrecognized cases
To control the spread of disease
To identify the source or vehicle of infection (to control or eliminate it)
To learn more about the disease itself (natural history of disease, clinical spectrum, descriptive epidemiology, and risk factors)

36. Really Useful Information
Disease Reporting in San Mateo County:
Call (650) (regular hours)
Call (650) (after hours – urgent needs)
Fax (650)
San Mateo County:
What diseases to report and how to report them
Restaurant inspection results
Beach and stream water quality testing
How to dispose of household hazardous wastes
Local/State bioterrorism and disaster resources
Local Data:
Immunizations:
American Public Health Assoc: