1. Introduction to Health Care and Public Health in the US Public Health (Part 2) Lecture c This material (Comp1_Unit8c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Public Health (Part 2) Learning Objectives 2 Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health (Lecture a) Discuss the activities and achievements of public health in the realm of communicable disease (Lecture a ) Compare and contrast the different types of terrorism and the different public health responses (Lecture b ) Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards (Lecture c ) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c

3. Chronic Diseases 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c The success of public health in combating infectious diseases has led to our current situation, where chronic diseases have taken the stage as the leading causes of death in the US 7 of the 10 leading causes of mortality are chronic diseases, led by the top 4: Heart disease, Cancer, Stroke, and Chronic lower respiratory diseases

4. Top Ten Leading Causes of Mortality in US Heart disease: 616,067 Cancer: 562,875 Stroke (cerebrovascular diseases): 135,952 Chronic lower respiratory diseases: 127,924 Accidents (unintentional injuries): 123,706 Alzheimer's disease: 74,632 Diabetes: 71,382 Influenza and Pneumonia: 52,717 Nephritis, nephrotic syndrome, and nephrosis: 46,448 Septicemia: 34,828 (CDC, 2007) 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c

5. Chronic Disease Topics 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c Chronic disease topics include: –Arthritis –Asthma & Allergies –Cancer –Chronic Fatigue Syndrome –Diabetes –Epilepsy –Heart Disease –Hemochromatosis –Hepatitis B –Hepatitis C –Iron Overload –Osteoporosis –Overweight and Obesity –Stroke (CDC, 2007)

6. Chronic Disease: Prevention 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c CDC estimates that 70% of deaths in the US are now caused by chronic diseases Public health focus on behaviour modification Chronic diseases mainly due to four modifiable health risk behaviors –lack of physical activity –poor nutrition –tobacco use –excessive alcohol consumption

7. Chronic Disease: Education 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c Since behavior modification is the main public health goal, the tools to effect that are – –Education and informational materials For the public For health care practitioners For policymakers –Funding opportunities –Recommendations, best practices, guidelines

8. World Health Organization (WHO) and Chronic Diseases 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c The WHO has developed the “Stepwise Framework” PLANNING –STEP 1: Estimate population need and advocate for action –STEP 2: Formulate and adopt policy –STEP 3: Identify policy implementation ste ps IMPLEMENTATION –Table of 3 steps

9. WHO Stepwise Framework 8.1 Table: The Stepwise Framework. (n.d.). Retrieved December 6, 2011, from World Health Organization website: http://www.who.int/chp/chronic_disease_report/p28_en.jpg 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c Policy implementation steps Population-wide interventionsInterventions for individuals National LevelSub-National Level Implementation step 1 CORE Interventions that are feasible to implement with existing resources in the short term. Implementation step 2 EXPANDED Interventions that are possible to implement with a realistically projected increase in or reallocation of resources in the medium term. Implementation step 3 DESIRABLE Evidence-based interventions which are beyond the reach of existing resources.

10. Environmental Public Health 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c Environmental public health is vital to population health Removal of lead from gasoline and from house paint are two of the numerous triumphs of this field Other critical functions include air and water quality monitoring and education, and hazardous waste management

11. Environmental Topics: By Means of Contact 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c One way of categorizing environmental topics is by their means of contact with the population, such as - –air quality –food protection –radiation protection –solid waste management –hazardous waste management –water quality –noise control –environmental control of recreational areas –housing quality –vector control Another categorization method is to organize topics by public health program,, as shown on the next slide.

12. Environmental Topics: By Public Health Programs Air Quality Bioterrorism Agents/Diseases Chemical Agents Environmental Hazards and Exposure Food Safety Hazardous Substances Hazardous Waste Sites Health Disorders and the Environment Herbicides Hydrocarbons Laboratory Measurements in People Lead Natural Disasters Pesticides Smoking and Tobacco Use Urban Planning for Healthy Places Vessel Sanitation and Health Water Quality 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c Public Health environmental programs and topics include:

13. Chronic Diseases and Environmental Public Health 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c There is some overlap between chronic diseases and environmental topics. Some examples – –Smoking, asthma, air quality –Cancer, environmental hazards and exposure, chemical agents Similarly, there are overlaps between communicable diseases and environmental topics, such as –Bioterrorism –Water quality and water-related diseases Divisions between different facets of public health can be artificial, created for efficiency of organization. In actuality, relationships between facets of public health are often complex rather than simple, as illustrated in the above examples.

14. Public Health (Part 2) Summary – Lecture c 14 In summary, the importance and impact of chronic diseases is discussed. Behavior modification is considered as a remediation tool. The World Health Organization’s Stepwise Framework is illustrated. Environmental public health topics are reviewed including some overlap with chronic diseases. Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c

15. Public Health (Part 2) Summary In summary, communicable diseases were discussed in detail, using notable examples including smallpox and polio. Public health disease outbreak investigations were discussed using a simplified food poisoning incident. Public health response was discussed for the four main categories of terrorism: bioterrorism, agricultural terrorism, chemical terrorism, and nuclear/radiation terrorism. Categorization of bioterrorism agents and the Laboratory Response Network were discussed. The importance and impact of chronic diseases was discussed. Behavior modification was considered as a remediation tool. The World Health Organization’s Stepwise Framework was illustrated. Environmental public health topics were reviewed, including some overlap with chronic diseases. 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c

16. Public Health (Part 2) References – Lecture c References Chronic Disease Prevention and Health Promotion. (n.d.). Retrieved December 6, 2011, from Centers for Disease Control and Prevention website: http://www.cdc.gov/chronicdisease/index.htm http://www.cdc.gov/chronicdisease/index.htm Chronic Diseases. (n.d.). Retrieved December 6, 2011, from World Health Organization website: http://www.who.int/topics/chronic_diseases/en/ http://www.who.int/topics/chronic_diseases/en/ Leading Causes of Death. (2007). Retrieved December 6, 2011, from Centers for Disease Control and Prevention website: http://www.cdc.gov/nchs/fastats/lcod.htmhttp://www.cdc.gov/nchs/fastats/lcod.htm Charts, Tables, Figures 8.1 Table: The Stepwise Framework. (n.d.). Retrieved December 6, 2011, from World Health Organization website: http://www.who.int/chp/chronic_disease_report/p28_en.jpg 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Public Health (Part 2) Lecture c