1. Public Health and Prevention M6920 September 18, 2001

2. Columbia University School of NursingM6920, Fall, 2001 Goals l An overview of the public health perspective l An introduction to the relationship of public health to personal care l The contribution of Healthy People 2010

3. Columbia University School of NursingM6920, Fall, 2001 The IOM report on Public Health l 1988 review of the system l Significant statement of the role of public health l Governmental public health: creating the conditions within which people can be healthy

4. Columbia University School of NursingM6920, Fall, 2001 IOM called for a PH system which performs l Assessment l Policy Development l Assurance

5. Columbia University School of NursingM6920, Fall, 2001 This system should include l Federal leadership l State organizational focus l Local presence

6. Columbia University School of NursingM6920, Fall, 2001 The scope includes l the maintenance of physical and emotional health l the reduction of threats to health l the provision of care when illness occurs l the quality of all of the above

7. Columbia University School of NursingM6920, Fall, 2001 Currently l The focus on cost of illness care overshadows health l Most "Health Professionals" are in the sick care business l There is only a weakly unified voice in public health l The system is poorly documented

8. Columbia University School of NursingM6920, Fall, 2001 Public Health l is founded on the idea of shared futures l an understanding of community l some degree of enlightened self-interest l acceptance of the role of government to achieve goals

9. Columbia University School of NursingM6920, Fall, 2001 Prevention triangles Population Oriented Prevention Clinical Preventive Services Primary Medical Care Secondary Medical Care Tertiary Medical CareRelative Investment Tertiary Prevention Secondary Prevention Primary Prevention 2% of $$

10. Columbia University School of NursingM6920, Fall, 2001 A familiar process l a continuous cycle of gathering information, deciding, acting, evaluating

11. Columbia University School of NursingM6920, Fall, 2001 Essential services of public health l surveillance l investigation l public information l community organization l policy development l regulation l service access and delivery l workforce l assurance of quality/ effectiveness l research

12. Columbia University School of NursingM6920, Fall, 2001 Public health in disasters l Surveillance identify a new risk monitor ongoing exposure l Limit threats to health l Communicate health information l Use legal authority if needed l Assure access to services

13. Columbia University School of NursingM6920, Fall, 2001 Role development in a changing world l convener l quality assurer l informer

14. Columbia University School of NursingM6920, Fall, 2001 A century of progress l Vaccination l Motor-vehicle safety l Safer workplaces l Control of infectious diseases l Decline in deaths from coronary heart disease and stroke l Safer and healthier foods l Healthier mothers and babies l Family planning l Fluoridation of drinking water l Recognition of tobacco use as a health hazard

15. Columbia University School of NursingM6920, Fall, 2001 Use of vaccines

16. Columbia University School of NursingM6920, Fall, 2001 Occupational Injury

17. Columbia University School of NursingM6920, Fall, 2001 Foodborne infections

18. Columbia University School of NursingM6920, Fall, 2001 Motor vehicle related deaths

19. Columbia University School of NursingM6920, Fall, 2001 Deaths from infectious diseases

20. Columbia University School of NursingM6920, Fall, 2001 Death from cardiovascular disease

21. Columbia University School of NursingM6920, Fall, 2001 Fertility rates, 1917-1997

22. Columbia University School of NursingM6920, Fall, 2001 Trends in tobacco use

23. Columbia University School of NursingM6920, Fall, 2001 State spending on tobacco prevention* *National Center for Tobacco-Free Kids, 1999 data New York

24. Columbia University School of NursingM6920, Fall, 2001 Healthier moms Maternal Mortality

25. Columbia University School of NursingM6920, Fall, 2001 and healthier babies Infant Mortality

26. Columbia University School of NursingM6920, Fall, 2001 Flouridated water

27. Columbia University School of NursingM6920, Fall, 2001 Community Health Improvement Process l Select priorities l Plan for each selected priority l Involve community partners at each step l Identify preferred outcomes and measures before you begin

28. Columbia University School of NursingM6920, Fall, 2001 Healthy People 2010 l National decade-long process l Began in late 1970’s l First cycle almost entirely “federal” l Second cycle (HP2000) involved many more groups l Third cycle just begun

29. Columbia University School of NursingM6920, Fall, 2001 Conceptual framework

30. Columbia University School of NursingM6920, Fall, 2001 Healthy People 2010 Increase Quality and Years of Healthy Life Healthy People in Healthy Communities Eliminate Health Disparities

31. Columbia University School of NursingM6920, Fall, 2001 Health status means improvement in... l Life expectancy l Burden of illness l Quality of life

32. Columbia University School of NursingM6920, Fall, 2001 Possible interventions l Health promotion l Health protection l Disease prevention l Care and treatment

33. Columbia University School of NursingM6920, Fall, 2001 Focus areas l Access to quality health services l Arthritis, osteoporosis/ chronic back condit’ns l Cancer l Chronic kidney disease l Diabetes l Disability/secondary conditions l HIV l Educat’l and commun- ity-based programs Environmental health l Family planning and sexual health l Food safety l Health communication l Heart disease and stroke l Immunizations and infectious diseases

34. Columbia University School of NursingM6920, Fall, 2001 Focus, cont. l Injury and violence Prevention l Maternal, infant, and child health l Medical product safety l Mental health l Nutrition l Occupational safety and health l Physical activity and fitness l Public health infrastructure l Respiratory diseases l Sexually transmitted diseases l Substance abuse l Tobacco Use l Vision and hearing l Oral health

35. Columbia University School of NursingM6920, Fall, 2001 l 1997 Baseline* 2010 Target % l All ages 86 96 l <17 years 93 96 l Adults 84 96 l.

36. Columbia University School of NursingM6920, Fall, 2001 Increase in specific source of ongoing care Target setting method: Better than the best

37. Columbia University School of NursingM6920, Fall, 2001 What would it take? l Genetics? l Physical environment? l Social environment? l Behavior? l Medical care? l ???

38. Columbia University School of NursingM6920, Fall, 2001 Substance abuse Reduce drug-related hospital emergency department visits. Target: 350,000 visits per year. Baseline: 542,544 drug-related hospital emergency department visits in 1998. Target setting method: 35 percent improvement.

39. Columbia University School of NursingM6920, Fall, 2001 What would it take? l Genetics? l Physical environment? l Social environment? l Behavior? l Medical care? l ???

40. Columbia University School of NursingM6920, Fall, 2001 Reduce hospitalizations for asthma Age Group1997 Baseline 2010 Target Rate per 10,000 under age 5 60.9 25 5 to 64 years 13.8 8 65 years and older 19.3 10 Target setting method: Better than the best.

41. Columbia University School of NursingM6920, Fall, 2001 What would it take? l Genetics? l Physical environment? l Social environment? l Behavior? l Medical care? l ???